![]() ![]() Conversely, the Diagnostic Interview Schedule for Children (DISC-IV Shaffer, Fisher, Lucas, Dulcan, & Schwab-Stone, 2000) generates pica (but not ARFID or RD) diagnoses, but is only suitable for children, despite evidence that pica, RD, and ARFID also occur in adults ( Delaney et al, 2015 Thomas & Murray, 2016). ![]() Both interviews are suitable for adolescents and adults only, despite epidemiological data suggesting that pica, RD, and ARFID are common in children ( APA, 2013). The Structured Clinical Interview for DSM-5 (SCID-5 First, Williams, Karg, & Spitzer, 2014) can also be used to diagnose ARFID but does not evaluate constructs relating to pica or RD. For example, the Eating Disorder Assessment for DSM-5 (EDA-5 Sysko et al., 2015) can be used to confer ARFID, pica, and RD diagnoses, although its diagnostic properties have not been evaluated for these groups. Additionally, they do not provide a multi-informant approach, despite the fact that parents are often included in the treatment of children and young people with ARFID ( Thomas & Eddy, in press). Crucially, none of these measures provides a continuous index of psychopathology severity or related impairment, which is essential for treatment planning, evaluation of clinical outcomes, and refinement of diagnosis. While some structured assessment tools to diagnose or screen for these disorders have been published, none of them evaluate both the presence and severity of all three disorders simultaneously. Both pica and RD may also be first diagnosed in adolescence or adulthood and have therefore been included in the Feeding and Eating Disorders chapter so they can be diagnosed across the lifespan ( Bryant-Waugh et al, 2010).ĭespite the inclusion of ARFID, pica and RD in DSM-5, a comprehensive measure to establish the severity and clinical features of these disorders is still lacking. The regurgitation should not primarily be due to a medical condition and should not occur exclusively in the course of other feeding and eating disorders ( APA, 2013 Hartmann et al., 2012). RD is characterized by repeated regurgitation of food for a period of at least a month. Pica is characterised by persistent eating of non-nutritive substances/items for at least one month its occurrence should be inappropriate to the individual’s developmental level, and not part of a culturally or socially normative practice ( APA, 2013 Hartmann, Becker, Hampton, & Bryant-Waugh, 2012). choking, vomiting) associated with eating ( APA, 2013 Thomas & Eddy, 2018). Instead, in ARFID, intake is restricted for reasons that may include avoidance based on sensory aspects of food or eating (e.g., taste, smell, texture) lack of interest in food or eating or because of the feared negative consequences (e.g. While AN is associated with body image disturbance and body weight or shape concerns, these are not core features of ARFID ( APA, 2013 Becker et al., under review). ![]() Although some presentations of ARFID resemble those of anorexia nervosa (AN) in terms of very restricted food intake and resultant weight loss or faltering growth, underlying motivations differ markedly ( APA, 2013). ARFID is characterized by avoidant and restrictive eating associated with failure to meet nutritional and/or energy requirements leading to: significant weight loss or failure to gain expected weight (or faltering growth in children) dependence on oral nutritional supplements or enteral feeding nutritional deficiencies and/or significant difficulties with psychosocial functioning. ARFID represents a revised and expanded version of the DSM-IV ( APA, 1994) feeding disorder of infancy and early childhood, in recognition that ARFID symptoms can occur at all ages. DSM-5 took a new lifespan approach, removing the DSM-IV section “Disorders Usually First Diagnosed During Infancy, Childhood and Adolescence” and introducing a “Feeding and Eating Disorders” chapter, which allows for diagnoses in adulthood as well as in childhood and adolescence. Avoidant/restrictive food intake disorder (ARFID), pica, and rumination disorder (RD) were recently added to a combined Feeding and Eating Disorders chapter in DSM-5 ( APA, 2013). ![]()
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