Feeding and eating disorders involve disturbed eating and eating-related behaviour, altered food consumption and absorption, and impaired physical and psychosocial health and wellbeing. Feeding and eating disorders include pica, rumination disorder, avoidant/restrictive food intake disorder (ARFID), anorexia nervosa (AN); bulimia nervosa (BN), binge eating disorder (BED), other specified feeding or eating disorder (OSFED), and unspecified feeding or eating disorders (USFED).
Specific changes to eating disorder diagnoses from the DSM-IV to the DSM-5 include revised diagnostic criteria for AN and BN, recognition of BED, and inclusion of descriptors of OSFEDs and USFEDs. The other major change is the inclusion of ARFID (previously feeding disorder of infancy or early childhood), pica, and rumination disorder; diagnoses that were previously listed under “disorders usually first diagnosed in infancy, childhood, or adolescence” not retained in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013).
• AN is characterised by persistent energy restriction, fear of weight gain or persistent behaviours that interfere with weight gain, and disturbed self-perceived weight and shape. Specifiers include restricting type (weight loss achieved via dieting, fasting, and excessive exercise, without recurrent binging or purging) or binge eating/purging type (recurrent episodes of binge eating or purging), in partial or full remission, and severity based on body mass index (BMI) criteria. The DSM-5 changes to diagnostic criteria include removing the term “refusal” in relation to maintaining normal body weight (Criteria A) and requiring amenorrhea (Criteria D).
• BN is characterised by recurrent binge eating episodes, inappropriate compensatory behaviours, and overvaluation of weight and shape. Specifiers include in partial or full remission and severity is based on frequency of compensatory behaviours.
• BED is characterised by recurrent binge eating episodes which involve eating a large amount of food and experiencing lack of control. Specifiers include in partial or full remission and severity is based on frequency of binge eating.
• ARFID is characterised by avoidance or restriction of food intake resulting in failure to meet nutritional and/or energy requirements. There has been refinement of diagnostic criteria from the previous name of feeding disorder of infancy or early childhood. Rumination is characterised by the repeated regurgitation of food after eating, the re-chewed food may be spat out or re-swallowed. Only one of the above diagnoses can be made during a single episode.