Feeding and Eating Disorders in the DSM-5 are defined as a group of psychological ailments that involve a persistent disturbance of eating or eating-related behavior, leading to altered consumption or absorption of food and significantly impairing physical health or psychosocial functioning (American Psychiatric Association, 2013a). Individuals with these disorders may present with a variety of symptoms, including, but not limited to, unhealthy preoccupations with food, body weight, and shape. Anorexia nervosa, for instance, is often characterized by an extreme fear of weight gain and a distorted body image, leading to a refusal to maintain minimal body weight. Bulimia nervosa presents through episodes of binge eating followed by inappropriate compensatory behaviors such as self-induced vomiting. Binge-eating disorder, the most common among these conditions, involves repeated episodes of eating large quantities of food without subsequent purging behaviors (Hudson, Hiripi, Pope, & Kessler, 2007). These disorders are complex and multifaceted, often co-occurring with other psychological issues such as depression and anxiety, and they significantly impact an individual’s emotional and physical well-being (American Psychiatric Association [APA], 2023).

Feeding and Eating Disorders in the DSM-5 represent a significant reorganization and expansion of this diagnostic category. The DSM-5 introduces a dedicated chapter for these disorders, bringing together all related diagnoses into a unified section to facilitate review and comparison. This chapter takes a lifespan approach to diagnosing eating disorders, which means it considers the presentation of these disorders across different ages. Changes in this edition include diagnostic revisions and the introduction of new disorders, like avoidant/restrictive food intake disorder and binge-eating disorder. Notably, while pica and rumination disorder remain largely unchanged, anorexia nervosa and bulimia nervosa have undergone some criteria changes​​.

The DSM-5 criteria for eating disorders characterize them as persistent disturbances of eating or eating-related behavior resulting in altered consumption or absorption of food, significantly impairing physical health or psychosocial functioning. This implies that these disorders can lead to serious health consequences if not treated effectively, including harm to the heart, digestive system, bones, teeth, mouth, and can be linked to other diseases, depression, anxiety, self-harm, and suicidal thoughts and behaviors​​​​.

Prevalence rates based on the DSM-IV criteria show that anorexia nervosa, bulimia nervosa, and binge-eating disorder affect both females and males, with binge-eating disorder being the most prevalent. Significantly, young women under age 20 are particularly affected, with one in eight likely to experience some form of diagnosable eating disorder​​.

A major goal of the DSM-5 revisions was to reduce the number of unspecified eating disorder diagnoses, previously categorized as eating disorder not otherwise specified (EDNOS). The addition of new disorders and criteria changes aimed to achieve this. However, a considerable number of cases still do not meet the revised criteria for any specific eating disorder in DSM-5, highlighting the complexity and diversity of these conditions​​.

As for the less common disorders like pica and rumination disorder, their prevalence is less clear and seems to be higher in specific populations, such as children with intellectual disabilities, pregnant women, adults with iron deficiency, and institutionalized persons. There are also no reported prevalence rates for avoidant/restrictive food intake disorder, indicating the need for further research and understanding of these disorders​​.

This is a brief summary of each of the feeding and eating disorders in the DSM-5-TR:

• Anorexia Nervosa: Individuals with this disorder typically present with a significant restriction of food intake leading to a notably low body weight. They often have an intense fear of gaining weight and a distorted perception of their body size or shape.
• Bulimia Nervosa: Characterized by recurring episodes of binge eating followed by compensatory behaviors such as self-induced vomiting, misuse of laxatives, or excessive exercise to prevent weight gain.
• Binge-Eating Disorder: Similar to bulimia, this disorder involves frequent episodes of eating large amounts of food. However, individuals do not engage in compensatory behaviors, which can lead to feelings of distress, guilt, or embarrassment about the binge eating.
• Pica: This eating disorder is marked by persistent eating of non-nutritive, non-food substances over a period of at least one month.
• Rumination Disorder: Involves the repeated regurgitation of food, which may be re-chewed, re-swallowed, or spit out, occurring over a period of at least one month.
• Avoidant/Restrictive Food Intake Disorder (ARFID): This is not characterized by a fear of gaining weight or body image disturbance, but rather by a significant lack of interest in eating or food, or avoidance based on the sensory characteristics of food or a past negative experience with food.
• Other Specified Feeding or Eating Disorder (OSFED): This category is for disorders that cause significant distress or impairment in social, occupational, or other areas of functioning but do not meet the full criteria for any of the disorders above.

Each of these disorders can significantly interfere with individual health and psychosocial functioning, and are often associated with other mental health conditions (American Psychiatric Association, 2023).

The shared characteristics across these disorders include a focus on body weight and shape, leading to dangerous eating behaviors that disrupt normal nutrition and overall health. These disorders often co-occur with psychological issues, and treatment usually requires a comprehensive approach that addresses medical, nutritional, and psychological needs to foster healthier eating habits and perspectives on food and body image​​.

Addressing stigma in the psychodiagnosis of Feeding and Eating Disorders requires a nuanced approach that acknowledges the complex interplay between cultural, social, and individual factors that contribute to the manifestation of these disorders. People struggling with these conditions might exhibit behaviors or express concerns that are often misunderstood or judged by society. For example, individuals with anorexia nervosa may be perceived as overly self-disciplined or vain due to their severe restriction of food intake and extreme thinness, despite suffering from a deep-seated fear of gaining weight and a skewed body image. Those with bulimia nervosa often experience cycles of binge eating and purging in secret, which can lead to feelings of shame and efforts to hide their disorder. Similarly, binge-eating disorder is frequently misconstrued as a lack of willpower rather than as a serious psychiatric condition, leading to further distress and isolation for the individual.

To combat stigma, clinicians and mental health professionals are encouraged to use person-first language, emphasize the biopsychosocial model of illness, and advocate for educational initiatives that challenge misconceptions and promote understanding of these disorders as legitimate medical conditions. This approach aims to reduce the shame and secrecy that often surround these disorders and to foster an environment in which individuals feel supported to seek help (APA, 2023).

The Etiology (Origins and Causes)

Research has shown that the origins of these disorders are not due to any single cause but are instead the result of a complex interplay of various factors:

• Genetic Vulnerability: Studies indicate that certain genetic factors may predispose individuals to eating disorders. For example, a study by Bulik et al. (2006) found that variations in the serotonin transporter gene could be associated with the risk of developing eating disorders.
• Neurobiological Factors: Abnormalities in brain structure and function, especially those related to the regulation of mood, stress, hunger, and satiety, have been observed in individuals with eating disorders. Kaye et al. (2009) found differences in the activity of brain circuits related to reward and inhibition in anorexia nervosa.
• Psychological Factors: Personality traits such as perfectionism, neuroticism, and impulsivity have been linked to eating disorders. Bardone-Cone et al. (2007) showed that perfectionism could be a significant factor in the development and maintenance of anorexia nervosa.
• Sociocultural Influences: Societal pressures regarding body image, particularly through media exposure, have been implicated in eating disorders. A study by Stice and Shaw (1994) demonstrated that exposure to media portraying the thin-ideal body could lead to body dissatisfaction and may contribute to an increased risk of eating disorders.
• Family and Interpersonal Factors: Dysfunctional family dynamics, such as high-conflict or overly controlling environments, and a history of trauma or abuse have been associated with the development of eating disorders (Le Grange & Loeb, 2007).

Risk Factors

Feeding and Eating Disorders are often accompanied by a range of comorbid conditions. Research has frequently reported high rates of psychiatric comorbidity, particularly mood disorders such as depression and anxiety disorders. For instance, Swinbourne and Touyz (2007) highlighted that depression is one of the most common comorbidities in individuals with anorexia nervosa and bulimia nervosa.

Anxiety disorders, including social phobia and obsessive-compulsive disorder, are also prevalent among these populations. Additionally, substance abuse disorders have been identified as a significant comorbidity, especially in those with bulimia nervosa, as indicated by the work of Holderness, Brooks-Gunn, and Warren (1994).

Personality disorders, particularly within Cluster C, have been associated with eating disorders, as noted by Cassin and von Ranson (2005). The presence of these comorbidities can complicate the course and treatment of Feeding and Eating Disorders, necessitating a comprehensive treatment approach.

References

Bardone-Cone, A. M., et al. (2007). Perfectionism and eating disorders: Current status and future directions. Clinical Psychology Review, 27(3), 384-405.

Bardone-Cone, A. M., Wonderlich, S. A., Frost, R. O., Bulik, C. M., Mitchell, J. E., Uppala, S., & Simonich, H. (2007). Perfectionism and eating disorders: Current status and future directions. Clinical Psychology Review, 27(3), 384-405.

Bulik, C. M., Slof-Op 't Landt, M. C., van Furth, E. F., & Sullivan, P. F. (2007). The genetics of anorexia nervosa. Annual Review of Nutrition, 27, 263-275.

Cassin, S. E., & von Ranson, K. M. (2005). Personality and eating disorders: a decade in review. Clinical Psychology Review, 25(7), 895-916.

Holderness, C. C., Brooks-Gunn, J., & Warren, M. P. (1994). Comorbidity of eating disorders and substance abuse review of the literature. International Journal of Eating Disorders, 16(1), 1-34.

Hudson, J. I., Hiripi, E., Pope, H. G., Jr., & Kessler, R. C. (2007). The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biological Psychiatry, 61(3), 348-358.

Kaye, W. H., Fudge, J. L., & Paulus, M. (2009). New insights into symptoms and neurocircuit function of anorexia nervosa. Nature Reviews Neuroscience, 10(8), 573-584.

Kaye, W. H., Wierenga, C. E., Bailer, U. F., Simmons, A. N., & Bischoff-Grethe, A. (2013). Nothing tastes as good as skinny feels: The neurobiology of anorexia nervosa. Trends in Neurosciences, 36(2), 110-120.

Le Grange, D., & Loeb, K. L. (2007). Early identification and treatment of eating disorders: Prodrome to syndrome. Early Intervention in Psychiatry, 1(1), 27-39.

Stice, E., & Shaw, H. (1994). Adverse effects of the media portrayed thin-ideal on women and linkages to bulimic symptomatology. Journal of Social and Clinical Psychology, 13(3), 288-308.

Swinbourne, J. M., & Touyz, S. W. (2007). The co-morbidity of eating disorders and anxiety disorders: a review. European Eating Disorders Review, 15(4), 253-274.