Eating disorders and development

Eating disorders typically peak at specific periods in development, notably sensitive and transitional periods such as puberty. Feeding and eating disorders in childhood are often the result of a complex interplay of organic and non-organic factors. Medical conditions, developmental problems and temperament are all strongly correlated with feeding disorders, but important contextual features of the environment and parental behavior have also been found to influence the development of childhood eating disorders. Given the complexity of early childhood eating problems, consideration of both biological and behavioral factors is warranted for diagnosis and treatment.
Revisions in the DSM-5 have attempted to improve diagnostic utility for clinicians working with feeding and eating disorder patients. In the DSM-5, diagnostic categories are less defined by age of patient, and guided more by developmental differences in presentation and expression of eating problems.
Avoidant/restrictive intake disorder (ARFID)
History
Avoidant/restrictive food intake disorder (ARFID) was added to the DSM-5 to better clinically describe a subset of eating disorder patients who previously had been diagnosed with eating disorder not otherwise specified (EDNOS), a much broader diagnostic category with less clinical utility. Although more studies need to be conducted, initial studies are validating ARFID as a distinct eating disorder with criteria separate from anorexia (AN) and bulimia (BN). Patients meeting criteria for ARFID typically have a longer history of symptoms prior to diagnosis and an earlier onset than AN or BN patients. They are also more likely to have a co-morbid medical condition or anxiety disorder.
Diagnostic criteria
An eating or feeding disturbance (e.g., apparent lack of interest in eating or food; avoidance based on sensory characteristics of food; concern about aversive consequences of eating) as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one (or more) of the following:
# Significant weight loss (or failure to achieve expected weight gain or faltering growth in children).
# Significant nutritional deficiency.
# Dependence on enteral feeding or oral nutritional supplements.
# Marked interference with psychosocial functioning.
The disturbance is not better explained by a lack of available food or by an associated culturally sanctioned practice. The eating disturbance does not occur exclusively during the course of anorexia nervosa or bulimia nervosa, and there is no evidence of a disturbance in the way in which one's body weight or shape is experienced. The eating disturbance is not attributable to a current medical condition or not better explained by another mental disorder. When the eating disturbance occurs in the context of another condition or disorder, the severity of the eating disturbance exceeds that routinely associated with the condition or disorder and warrants additional clinical attention recent epidemiological studies have found that the average age of onset of anorexia nervosa has moved from the previously from an average age of onset of 13-17 to a current younger age of onset of 9-12. Among individuals with an eating disorder, 86% report the onset of the eating disorder by age 20, and 43% report the onset between the ages of 16 and 20.6. Corresponding with the age of onset, 95% of the population with current eating disorders are between the ages of 12 and 25.
Diagnostic criteria
Anorexia is characterized by a significant reduction in energy intake which leads to a low body weight given age, sex, development, and physical health considerations.
* Individuals with anorexia also experience a significant fear of weight gain or engage in behaviors that interfere with weight gain.
* The illness is also characterized by a disturbance in body image, a significant focus and evaluation of self based on body weight, and/or lack of recognition of the consequences and seriousness of the current low body weight.
* Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight.
Anorexia has two subtypes: the restricting type and the purging type. This is based on whether an individual engages in or does not engage in bingeing and purging behaviors.
Anorexia is characterized as mild, moderate, severe, or extreme based on the extent of weight loss.
Diagnostic criteria
Bulimia is characterized by repeated episodes of binge eating followed by the use of compensatory behaviors.
*The binge eating and compensatory behaviors occur recurrently
*An individual experiences a sense of lack of control during the binge eating.
*Self evaluation is highly influenced by body image and body perceptions.
The disorder can be characterized as mild, moderate, severe, or extreme based on the number of compensatory behaviors per week.
Diagnostic criteria
Binge eating disorder is characterized by repeated binge eating episodes.
This includes:
*Eating an objectively large amount of food in a short period of time.
*Experiencing a sense of lack of control while eating.
*Feeling self-deprecating based on eating behavior.
The severity is classified by the number of binge eating episodes per week.<ref name="DSM-5"/>

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