Page 100 Complete Your CE Test Online - Click Here IDENTIFICATION OF OTHER SPECIFIED FEEDING OR EATING DISORDERS The recently published DSM-5 includes information on a newly described disorder and also describes a category of “other specified feeding or eating disorder.” Avoidant/restrictive food intake disorder Avoidant/restrictive food intake disorder (ARFID) replaces and extends the DSM-IV diagnosis of feeding disorder of infancy or early childhood. The primary diagnostic characteristic of this disorder is avoidance or restriction of food intake[1] . Diagnostic criteria for ARFID are[1] : ● ● An eating or feeding disturbance characterized by ongoing failure to meet appropriate nutritional and/or energy needs associated with one or more of the following[1] : ○ ○ Significant weight loss or failure to achieve expected with gain or faltering growth in children. ○ ○ Significant nutritional deficiency. ○ ○ Dependence on enteral feeding oral nutritional supplements. ○ ○ Significant interference with psychosocial functioning. Nursing consideration: The eating or feeding disturbance can be manifested as a lack of interest in eating of food or adverse consequences of eating[1] . This eating or feeding disturbance is not more appropriately explained by lack of available food or a cultural practice. ● ● The eating or feeding disturbance does not occur exclusively during the course of anorexia nervosa or bulimia nervosa. There must not be evidence of a disturbance in the way one’s body shape or weight is experienced. ● ● The eating disturbance cannot be attributed to a concurrent medical condition or better explained by another mental disorder. Other specified feeding or eating disorders This category as published in the DSM-5 applies to disorders in which symptoms exist that are characteristic of a feeding and eating disorder that causes significant distress or functional impairment at home, at work, at school, in social settings or other important areas of functioning. However, these symptoms do not meet the full criteria for any of the disorders in the feeding and eating disorders diagnostic class[1] . Examples of presentations that are part of the “other specified feeding or eating disorders” are[1] : ● ● Atypical anorexia nervosa: This disorder is described as meeting all of the criteria for anorexia nervosa, except that the affected person, despite her/his weight loss, remains within or even above the normal weight range. ● ● Bulimia nervosa (of low frequency and/or limited duration): This disorder exists when all of the criteria for bulimia nervosa are met except that the affected person binges and performs inappropriate purging behaviors (on average) less than once a week and/or for less than three months. ● ● Binge-eating disorder (of low frequency and/or limited duration): The presentation of symptoms meets all of the criteria for binge-eating disorder except that the binge-eating takes place, on average, less than once a week and/or for less than three months. ● ● Purging disorder: Recurrent purging behaviors occur in order to influence weight or shape. However, binge eating does not occur. Examples of purging behaviors include self-induced vomiting and/ or abuse of laxatives, diuretics, or other medications. ● ● Night eating syndrome: This disorder is characterized by recurrent episodes of night eating. This may include eating after waking up from sleep or by excessive food consumption after the evening meal. The affected person is aware of and remembers the eating. The disorder is not better explained by external factors such as changes in the sleep-wake cycle or by social norms. This pattern of night eating is not more appropriately explained by binge-eating disorder or other mental disorders, including substance use, nor can it be attributed to another medical disorder or to the effects of medication. OBESITY Definition Obesity is defined as an excess of body fat[9] . The medical definition depends on the amount of body fat a person has, which means that a person can weigh more than is believed to be healthy, but is medically not obese. For example, athletes may weigh more than what is normally considered to be healthy. However, their excess weight is muscle, not fat. Therefore, they are not considered to be obese[25] . Until quite recently, obesity was defined as weighing at least 20% more than the ideal body weight. This definition has been replaced by the body mass index (BMI), which is based on a person’s height and weight and provides a better estimate of body fat. BMI is calculated by dividing weight in kilograms by height in meters, squared. It can also be calculated by multiplying weight in pounds by 705 and then dividing by height (as measured in inches) twice. Obesity is defined as having a BMI of 30 or more. Overweight is defined as having a BMI between 25 to 29.9[25] . There are some healthcare experts who question if obesity should be classified as an eating disorder, since they may equate obesity with a pathological relationship with food. Still, more experts point out that weight alone does not meet the criteria for eating disorders. Therefore, while obesity alone is not sufficient evidence of an eating disorder, it is important to evaluate persons who are obese for the presentation of signs and symptoms of eating disorders[26] . Nursing consideration: It is important to be objective and tactful when assessing obese persons for the possibility of eating disorders[1] .