1. Eating Disorders & DSM-5 Brenda L. Wolfe, Ph.D. Eating Disorders Institute of New Mexico (SM) www.EatingDisordersNM.com blwolfe@swcp.com

2. Disclaimer I am the Director of the Eating Disorders Institute of New Mexico. I am adjunct/volunteer faculty to University of New Mexico Psychology Department & School of Medicine. All the pages of my DSM-IV are dog-eared and frayed. Those of my DSM-5 are still almost pristine (except for the F&E D/O pages).

3. OBJECTIVE: IDENTIFY THE CHANGES IN DIAGNOSTIC CRITERIA FOR EATING DISORDERS FROM DSM IV TO DSM 5

4. Feeding and Eating Disorders Mutually Exclusive May be Diagnosed with Other F&ED Rumination Disorder ◦ IV – F&ED of Infancy or Early Childhood Avoidant/Restrictive Food Intake D/O ◦ IV – F&ED of Infancy or Early Childhood Anorexia Nervosa Bulimia Nervosa Binge Eating Disorder ◦ IV – ED NOS (Appendix) Other Specified/Unspecified F or E D/O ◦ IV – ED NOS Pica ◦ IV – F&ED of Infancy or Early Childhood

5. Pica 307.52 (F98.3 kids, F50.8 adults) Persistent eating of non-nutritive, nonfood substances > 1 month The eating... is inappropriate to the developmental level … … not part of a culturally supported or socially normative practice. If … in the context of another mental … medical d/o, is sufficiently severe to warrant additional clinical attention. Specify: In remission if full criteria not met for a sustained period of time

6. Rumination Disorder 307.53 (F98.21) A. Repeated regurgitation of food > 1 month, … re-chewed, re-swallowed, or spit out. B. … not attributable to assoc GI or other medical condition. C. … not exclusively during AN, BN, BED, ARFID D. If … context of other d/o, … severe to warrant additional clinical attention. Specify: In remission … full criteria not met … sustained period of time

7. Avoidant/Restrictive Food Intake D/O 307.59 (F50.8) A. … (e.g., lack of interest … ; avoidance based on sensory characteristics …; concern about aversive consequences of eating) … by persistent failure to meet appropriate nutritional and/or energy needs associated with 1+ of:  Significant weight loss (or failure to achieve expected … in children).  Significant nutritional deficiency.  Dependence on enteral feeding or oral nutritional supplements.  … interference w/psychosocial functioning. B. Not … lack of available food or culturally sanctioned practice. C. … not … exclusively during AN or BN, and no … disturbance in the way one's body weight or shape is experienced. D. If … context of other d/o, … severe to warrant additional clinical attention Specify: In remission …Critical change: greater specificity

8. Anorexia Nervosa 307.1 A. Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal, or, for children and adolescents, less than that minimally expected. B. Intense fear of gaining weight or becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight. C. Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight. D. (deleted amenorrhea requirement)

9. AN – cont’d Specify whether: (F50.01) Restricting: … last 3 mo, has not engaged in … binge … purge … weight loss … by dieting, fasting, excessive exercise. (F50.02) Binge-eating/purging: … last 3 mo Specify if: In partial remission: … sustained … B or C still met In full remission: … no criteria … sustained period of time Specify current severity: Mild < 17, Mod 16-16.99, Sev 15-15.99, Extr < 15

10. Bulimia Nervosa 307.51(F50.2) A. Recurrent … binge eating. … characterized by both …: 1.Eating, in a discrete period of time (e.g., w/in 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time under similar circumstances 2.A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating) B. Recurrent inappropriate compensatory behaviors … to prevent weight gain, e.g., self-induced vomiting, misuse of laxatives, diuretics, (deleted “enemas”) or other medications, fasting; or excessive exercise. C. The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months. D. Self-evaluation is unduly influenced by body shape and weight. E. … does not occur exclusively during episodes of AN.

11. BN – cont’d Specify if: In partial remission: … some but not all criteria have been met for sustained time In full remission: … none of criteria met for sustained time Specify current severity: (adjustable) Mild 1–3 icb/wk, moderate 4-7 icb/wk, severe 8-13 icb/wk, extreme 14+ icb/wk (Deleted purging/non-purging types)

12. Binge Eating D/O 307.51 (F50.8) A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both : 1.Eating, in a discrete period of time (e.g., … 2-hrs), an amount … that is definitely larger than most …would eat in a similar period of time/circumstances 2.A sense of lack of control … B. The binge-eating episodes are associated with 3+ of the following: 1.Eating much more rapidly than normal 2.Eating until feeling uncomfortably full 3.Eating large amounts of food when not feeling physically hungry 4.Eating alone because of feeling embarrassed by how much one is eating 5.Feeling disgusted with oneself, depressed, or very guilty after overeating C. Marked distress regarding binge eating is present.. D. The binge eating occurs, on average, at least once a week for 3 months. E. … not associated with the recurrent use of inappropriate compensatory behavior and does not occur exclusively during the course BN or AN.

13. BED – cont’d Specify if: In partial remission — frequency < 1 binge/wk for sustained time In full remission — no criteria met for sustained time Specify current severity: Mild: 1–3 binge/wk Moderate: 4-7 binge/wk Severe: 8-13 binge/wk Extreme 14+ binge/wk

14. Other Specified F or E D/O 307.59 (F50.8) … Sx … do not meet full criteria … [and] the clinician chooses to communicate the specific reason … e.g.: Atypical AN: [specifics] BN of low freq and/or limited duration: [specifics] BED low freq or ltd duration Purging d/o: [all but binge] Night Eating Syndrome: not better explained by …

15. Unspecified Feeding or Eating Disorder 307.50 (F50.9) Same as Other Specified F or E D/O but either the clinician chooses not to specify the reason diagnostic criteria for another F&E D/O are not met, or there is insufficient information to make a more specific diagnosis

16. EATING DISORDERS INSTITUTE OF NEW MEXICO (SM) Dr. Brenda L. Wolfe, Ph.D. 505-884-5700, Extension 101 blwolfe@swcp.com www.EatingDisordersNM.com (SM) Service Mark of Brenda L Wolfe PhD PC