Eating Disorders in Adolescents: How does the DSM-5 Change the Diagnosis?

Section: Discussionsupporting

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Implications of DSM‐5 for the diagnosis of pediatric eating disorders

Limburg

Shu

Watson

et al. 2018

“…DSM‐5 criteria for Anorexia Nervosa (AN) and Avoidant Restrictive Food Intake Disorder (ARFID) provide more inclusive descriptions for children based on both empirical data and clinical experience. For AN, children who may have met most of the DSM‐IV‐TR (APA, ) criteria, but were unable to articulate typical body image concerns, or who had not achieved menarche, are more easily captured with DSM‐5 criteria (Fisher, Gonzalez, & Malizio, ). Children with ARFID are described by current literature as a heterogeneous group and include those who lack interest in eating or food, are avoidant based on the sensory characteristics of food, or avoid food secondary to an aversive eating episode (Thomas et al, ; Mammel & Ornstein, ).…”

Section: Introductionmentioning

confidence: 99%

Children with avoidant/restrictive food intake disorder and anorexia nervosa in a tertiary care pediatric eating disorder program: A comparative study

Lieberman

Houser

Voyer

et al. 2019

Objective The purpose of this study was to examine the medical and psychological characteristics of children under the age of 13 years with avoidant restrictive food intake disorder (ARFID) and anorexia nervosa (AN) from a Canadian tertiary care pediatric eating disorders program. Method Participants included 106 children assessed between 2013 and 2017 using the Diagnostic and Statistical Manual for Mental Disorders, 5th edition (DSM‐5). Data were collected through clinical interviews, psychometric questionnaires, and chart review. Information collected included medical variables (e.g., weight, heart rate, need for inpatient admission, and duration of illness from symptom onset); medical comorbidities (e.g., history of food allergies, infection, and abdominal pain preceding the eating disorder); and psychological variables (e.g., psychiatric comorbidity, self‐reported depression and anxiety, and eating disorder related behaviors and cognitions). Results Children with ARFID had a longer length of illness, while those with AN had lower heart rates and were more likely to be admitted as inpatients. Children with ARFID had a history of abdominal pain and infections preceding their diagnoses and were more likely to be diagnosed with a comorbid anxiety disorder. Children with AN had a higher drive for thinness, lower self‐esteem, and scored higher on depression. Discussion This is the first study to look at DSM‐5 diagnosis at assessment and include psychometric and interview data with younger children with AN and ARFID. Understanding the medical and psychological profiles of children with AN and ARFID can result in a more timely and accurate diagnosis of eating disorders in younger children.

“…Despite reports of cases in children as young as 5 year old (Madden, Morris, Zurynski, Kohn, & Elliot, ), surprisingly little is known about the presentation of childhood onset EDs (ChED). In the Fifth Edition of the Diagnostic and Statistical Manual (DSM‐5) (American Psychiatric Association, ), the criteria for AN and bulimia nervosa (BN) were modified and four diagnoses (avoidant/restrictive food intake disorder (ARFID), binge‐eating disorder, pica, and rumination disorder) were added, in part to make diagnosis more applicable and appropriate for premenarchal children (Atkins & Silber, ; Eddy et al, ; Fisher, Gonzalez, & Malizio, ; Fosson, Knibbs, Bryant‐Waugh, & Lask, ; Peebles, Wilson, & Lock, ; Rosen, ). AN and ARFID are the most common restrictive Feeding and Eating Disorders (FEDs) in children sharing symptoms such as severe food restriction and weight loss (or failure to gain weight as expected) (Fisher et al, ; Forman et al, ; Nicely, Lane‐Loney, Masciulli, Hollenbeak, & Ornstein, ; Norris et al, ; Ornstein et al, ).…”

Section: Introductionmentioning

confidence: 99%

Classification of childhood onset eating disorders: A latent class analysis

Pinhas

Nicholls

Crosby

et al. 2017

This study tested the hypothesis that latent class analysis (LCA) would successfully classify eating disorder (ED) symptoms in children into categories that mapped onto DSM-5 diagnoses and that these categories would be consistent across countries. Childhood onset ED cases were ascertained through prospective active surveillance by the Australian Paediatric Surveillance Unit, the Canadian Paediatric Surveillance Program, and the British Paediatric Surveillance Unit for 36, 24, and 14 months, respectively. Pediatricians and child psychiatrists reported symptoms of any child aged ≤ 12 years with a newly diagnosed restrictive ED. Descriptive analyses and LCA were performed separately for all three countries and compared. Four hundred and thirty-six children were included in the analysis (Australia n = 70; Canada n = 160; United Kingdom n = 206). In each country, LCA revealed two distinct clusters, both of which presented with food avoidance. Cluster 1 (75%, 71%, 66% of the Australian, Canadian, and United Kingdom populations, respectively) presented with symptoms of greater weight preoccupation, fear of being fat, body image distortion, and over exercising, while Cluster 2 did not (all p < .05). Cluster 1 was older, had greater mean weight loss and was more likely to have been admitted to an inpatient unit and have unstable vital signs (all p < .01). Cluster 2 was more likely to present with a comorbid psychiatric disorder (p < .01). Clusters 1 and 2 closely resembled the DSM-5 criteria for anorexia nervosa and avoidant/restrictive food intake disorder, respectively. Symptomatology and distribution were remarkably similar among countries, which lends support to two separate and distinct restrictive ED diagnoses.