By BARBARA WILLIAMSON
“The Diagnostic and Statistical manual of Mental Disorders,” referred to as the DSM-5, is compiled and published with the blessing of the American Psychiatric Association. It is the manual which all mental health providers use to formulate a diagnosis in order to create the most appropriate treatment.
The last time this manual was revised was in 2000. With the new edition, published in the fall of 2013, we have some changes.
The book is divided into sections, and in “Feeding and Eating Disorders,” we find a new diagnosis, “avoidant/restrictive food intake disorder.”
The main diagnostic feature of this disorder is avoidance or restriction of food intake, manifested by clinically significant failure to meet requirements for nutrition or insufficient energy through oral intake of food.
One or more of the following key features must be present: significant weight loss, significant nutritional deficiency, dependence on enteral (tube) feeding or oral nutritional supplements, or marked interference with psychosocial functioning.
Another important criterion in making this diagnosis states, “The disturbance is not better explained by lack of available food or by an associated culturally sanctioned practice.”
The diagnostic markers include malnutrition, low weight, growth delay and the need for artificial nutrition in the absence of any medical condition other than poor intake.
Most of us are familiar with anorexia and bulimia. One of the major differences between anorexia and avoidant/restrictive food intake disorder is there is no disturbance in the manner in which the patient’s body weight or shape is experienced.
With anorexia, the patient’s perception of body image is distorted, the patient seems to continue to see fat areas on the body even when it appears thin or emaciated.
With avoidant/restrictive food intake disorder, the restriction of food is not so much about appearance as it is about taste or texture and often associated with a previous negative experience, such as choking on food.
Infants or young children who may have had gastro testing or who experienced periods of vomiting may develop this disorder in response to these negative and often-frightening situations.
Before making this diagnosis, there are a number of issues to consider and rule out. These include anorexia, bulimia, medical conditions which would include gastrointestinal disease, food allergies and intolerances and any other medical condition which would inhibit nutrition.
Also to be ruled out would be major depression, specific phobias and other anxiety disorders.
Williamson is a licensed professional clinical counselor at The Center for Mental Health and Well-Being, Findlay. If you have a mental health question, please write to Mental Health Moment, The Courier, P.O. Box 609, Findlay, OH 45839.
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