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Which Organization Sets The Standards For Diagnosing Eating Disorders

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Other Types Of Feeding Or Eating Disorders

Bulimia nervosa – causes, symptoms, diagnosis, treatment & pathology

The DSM-V update also included two other forms of eating disorder: “other specified feeding or eating disorder” and “eating disorder not otherwise specified,” which had been previously lumped together in the DSM-IV-TR as eating disorder not otherwise specified . Here are the ways they differ, according to the new edition:

  • Other specified feeding or eating disorder: This term is more specific and applies primarily to people with some or most of the symptoms of anorexia nervosa, bulimia nervosa, or binge-eating disorder but arent experiencing symptoms often enough, or havent been suffering long enough to qualify for a full diagnosis. It also includes purging disorder, which occurs when someone uses purging behaviors but does not engage in binge-eating behaviors . To meet criteria for OSFED, a person must present with clinically significant distress and impairment, but do not meet the full criteria for any of the other disorders. Another example of OSFED is when someone meets the criteria for binge eating disorder but engages in binging behaviors at a lower frequency or a limited period.
  • Eating disorder not otherwise specified: This broader category encompasses problems that dont fit into any current category or when the diagnosing professional doesnt have enough information .

Anorexia Nervosa In Children And Adolescents

Although the essential psychological features are similar, children and younger adolescents may present with delayed puberty or stunted growth as well as weight loss. Parents or teachers are generally the ones who raise concern and the young person may resist medical attention. Some young people will voice anxieties around unwanted aspects of development, particularly if they have experienced early puberty or feel unable to engage with their peers increasing adolescent independence and social experimentation. In some, bullying or teasing about weight may have provoked this concern.

Although the principles of making the diagnosis are the same as in adults and are often straightforward, the greatest diagnostic difficulty occurs in the youngest cases. In children between the ages of around eight and 12, the condition is less common than in older individuals and should be distinguished from other types of eating disturbance seen in middle childhood, such as selective eating and food avoidance emotional disorder. By definition feeding disorder of infancy and childhood has onset below age six. In pubescent cases with primary amenorrhoea, it can sometimes be difficult to judge whether puberty has been delayed from the normal variation in timing of puberty.

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Adverse Life Events And Difficulties

Severe life stresses have been implicated in the aetiology of both and , with approximately 70 per cent of cases being triggered by severe life events or difficulties. These stresses most commonly occur in the area of close relationships with family or friends . One controlled study of anorexia nervosa in adolescents suggested that a severe independent negative life event had occurred in the year before onset of approximately one quarter of an adolescent series and this was associated with a good prognosis. Particular attention has focused on the experience of childhood sexual abuse as a potential predisposing factor. There is little persuasive evidence that either sexual abuse or other stressful life events are specific predisposing factors for eating disorders rather than psychiatric disorder per se. Childhood sexual abuse did not emerge as a significant predictor of the onset of binge eating in the only prospective study to date

Transgenderism As A Mental Disorder

Evidenced Based Selected Response

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition offers four specific diagnoses that are potentially applicable to transgendered persons. These are gender identity disorder in adolescents and adults and in children , gender identity disorder not otherwise specified , and transvestic fetishism . The diagnosis of GID is generally reserved for the most severely gender dysphoric adults and adolescents, persons who usually meet the criteria for transsexualism . Transvestic fetishism, a paraphilia, could be the diagnosis given to some cross-dressers. GIDNOS is the most general of the DSM-IV diagnoses, and is potentially applicable to a wide variety of transgendered persons . According to DSM-IV guidelines, any of these diagnoses requires evidence of distress or impairment in functioning; functional impairment that is solely the result of societal prejudice based on perceived social deviance does not meet this criterion . It is thus important to emphasize that being transgendered does not in itself constitute a mental disorder according to DSM-IV.

Nevertheless, the diagnoses of GID and transvestic fetishism are still considered pejorative by many in the transgendered community. They see the diagnosis of GID in particular as stigmatizing of nonnormative gender behavior, in much the same way that homosexuality was pathologized before its removal from the list of mental illnesses by the American Psychiatric Association in 1980.

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Atypical Eating Disorders In Children And Adolescents

Atypical eating disorders are relatively commonly diagnosed in childhood, in part because of the difficulty in strictly applying existing diagnostic criteria for and , and in part because of an ongoing lack of clarity about the classification of eating disturbances in this age group. Children and younger adolescents may present with a range of other types of clinical eating disturbance, which may be different in terms of psychopathology to anorexia nervosa/bulimia nervosa presentations . They frequently develop in those who have suffered feeding disorders of childhood and sometimes the distinction can be a difficult one. Some have suggested that atypical eating disorders probably occur more commonly and some have suggested modification to the ICD10 criteria for the diagnosis of eating disorders in children is required. has not been systematically investigated in this age group.

The Relationship Of The Evidence Base For Adults To That For Children And Adolescents

In the absence of a strong body of treatment research in the child and adolescent literature, it is tempting to extrapolate from adult findings, but the validity and limitations of doing so requires careful consideration. A key argument in favour of extrapolating from adult findings is that adolescence is a developmental stage that is not defined merely by age. It can be argued that many young adults with eating disorders are still in the throes of addressing the challenges of adolescence and indeed developmental difficulties have been thought to underlie the aetiology of in particular . A second argument is that the essential features of anorexia nervosa and are consistent across the age spectrum both in terms of characteristic behaviours , specific psychopathology and non-specific features . Thirdly some of the literature reports combined adolescent/adult case series without separate analysis. Finally some of the treatments that have been found to be effective in adult eating disorders are effective in the treatment of adolescents with other conditions .

When considering the literature on pharmacotherapy, one should be aware of differences in the pharmacodynamics and pharmacokinetics in children. In general the latter means that children and adolescents require higher doses of drugs per kg body weight to attain similar blood levels and therapeutic effect, owing to childrens more rapid metabolism by the liver and clearance by the kidney.

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The Impact Of Changes In The Diagnosis Of Binge Eating Disorder

This column is dedicated to covering a variety of topics relevant to the multidisciplinary care of the bariatric surgical patient.

Column Editor: Karen Schulz, RN, CBN, MSN President of the Integrated Health Section of the ASMBS; Clinical Nurse Specialist, Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio.

This Month: The Impact of Changes in the Fiagnosis if Binge Eating Disorder

Dr. Berman is a Board Certified Clinical Psychologist. He is the Clinical Director of Lifespan Counseling Associates in Beavercreek, Ohio and Clinical Professor in the School of Professional Psychology, Wright State University, Dayton, Ohio.

Financial disclosures: The author reports no conflicts of interest relevant to the content of this article.

IntroductionBinge eating was first described in 1957 as a condition that involved eating large amounts of food without a regular pattern and in an orgiastic manner. Following this early attempt to define binge eating, views of the phenomenon ranged from overindulgence to a true problem, something that has a negative impact on many aspects of life.

With the very recent publication of DSM-5, BED is offered as a new, stand-alone category of psychiatric disturbance. While many of the criteria have not changed from DSM-IV, the main change is in the frequency and duration of bingeing. The new criteria require an ongoing pattern of at least once a week for a duration of three months .

Clinical Utility Of The Diagnoses

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Clinician ratings of the clinical utility for the diagnostic guidelines of ICD-10 and ICD-11 for the conditions studied in this set of research questions are shown in Table;. For most diagnoses, the pattern of results for ICD-11 as compared to ICD-10 was the same. ICD-11 was rated more favorably than ICD-10 for each diagnosis in terms of how easy the diagnostic categories were to use, how well the guidelines fit the case vignettes, and how clear the guidelines were.

Table 5 Clinical utility ratings for ICD-11 categories as compared to closest ICD-10 categories

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    Subsequent Editions Of The Dsm

    The DSM-III included an explicit conceptualization of a mental disorder. Parenthetically, the relationship between a mental disorder and socially deviant behavior was clarified: . This clarification has run through the later editions of the DSM. The DSM-5 is more explicit: Socially deviant behavior and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above .

    Under the DSM-5, should debilitating distress about sexual orientation occur in an individual, it could be listed under the diagnostic category of Unspecified Mental Disorder which reads as follows: This category applies to presentations in which symptoms characteristic of a mental disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any mental disorder . In theory, this diagnostic category would allow a clinician to acknowledge a clinically relevant degree of distress and impairment due to one’s sexual orientation without any implication that it is the orientation itself that is responsible for the distress. Thus, it appears that the DSM-5 has completely severed the association between homosexuality and mental disorder, 127;years after its first appearance in Psychopathia Sexualis.

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    Eating Disorders Disproportionately Affect Young Women

    Franco of the cleveland clinic. Which organization sets the standards for diagnosing eating disorders? With early intervention and aggressive treatment, affected adolescents and young it also discusses our current understanding of the causes of eating disorders as well as current treatment methods, which involve a multidisciplinary approach. Eating disorders have the highest mortality rate of any mental illness. Learn more about diagnosing eating disorders from discovery health.

    The eating disorders test is a scientifically validated instrument to assess the presence of eating restraint, eating concern, shape concern, and 5. Sometimes a pediatrician or family practice doctor will diagnose an eating disorder after noticing. The already existing disorders of pica, rumination disorder, an and bn reflect some minor changes as well. The diagnosis is made following a full assessment of psychological and physical wellbeing, as well as specific eating disorder symptoms. The three most commonly diagnosed eating disorders are anorexia nervosa, bulimia nervosa, and.

    It’s important to get diagnosed by a professional so that you can access appropriate treatment. Which organization sets the standards for diagnosing eating disorders? Usually the eating disorder starts in the mind. Treatment of an eating disorder generally includes a team approach. Eating disorders are diagnosed based on signs, symptoms and eating habits.

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    Physical And Social Consequences

    Although in the acute stages of subjective distress may be limited, emotional disturbance is common, chiefly comprising anxiety and mood symptoms. With time, emotional difficulties usually increase along with a range of physical and social difficulties, including becoming unable to care for oneself adequately, reducing or stopping leisure activities, interrupting educational goals and losing personal autonomy. These affect the persons quality of life and increase the reliance on and the importance of the eating disorder.

    Depression is a common comorbid diagnosis, with rates of up to 63 per cent in some studies , while obsessive-compulsive disorder has been found to be present in 35 per cent of patients with .

    Brain volume is reduced in . There are two small longitudinal studies, which have examined the structural changes in the brain of adolescents after full weight gain . Both found persistent deficits in grey matter although there was recovery of white matter . This supports the finding of grey matter deficits in people who have made a full recovery from their eating disorder . One post-mortem study reported that there was a reduction in basal dendritic fields and dendritic spine density .

    Although little is known of the effects short or long term of extreme weight loss on brain development and function in children, it is possible that such weight loss may have both short and long-term effects on cognitive functioning.

    The Aetiology Of Eating Disorders

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    The aetiology of eating disorders in common with most other psychiatric disorders is generally considered to be multifactorial; no single aetiological factor in isolation can account for the development of the disorder in an individual, nor can it be seen to account for the variation among individuals . Whether or not a person develops an eating disorder will depend on their individual vulnerability, consequent on the presence of biological or other predisposing factors, their exposure to particular provoking risk factors and on the operation of protective factors. Following the establishment of the disorder a further combination of risk and protective factors may act to maintain the condition or determine whether an individual recovers.

    A recent of prospective and experimental studies has systematically reviewed the evidence for aetiological and maintaining factors .

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    Symptoms Presentation And Patterns Of Illness

    is a syndrome in which the individual maintains a low weight as a result of a pre-occupation with body weight, construed either as a fear of fatness or pursuit of thinness. In anorexia nervosa, weight is maintained at least 15 per cent below that expected, or in adults body mass index calculated as weight in kilograms divided by height in metres squared is below 17.5 kg/m2. In younger people, the diagnosis may be made in those who fail to gain weight during the expected growth spurt of puberty, as they can become underweight without weight loss.

    Weight loss in is induced by avoiding fattening foods, sometimes supported by excessive exercising or self-induced purging . As a consequence of poor nutrition, a widespread endocrine disorder involving the hypothalamic-pituitary-gonadal axis develops, manifest in women by amenorrhoea and in men by a lack of sexual interest or potency. In prepubertal children, puberty is delayed and growth and physical development are usually stunted.

    Typically individuals are persuaded to seek help by concerned family members, teaching staff or general practitioners with whom they consult about physical consequences. Sometimes, however, the person begins to appreciate the damaging effects of the disorder and may seek help in their own right. Children and adolescents are almost always brought to treatment, very rarely actively seeking help initially and can present more complex diagnostic challenges .

    Description Of Study Design

    This was an experimental, vignette-based case-controlled study implemented via the internet with participation from a large, global, multilingual, and multidisciplinary sample of mental health professionals. The current study is part of a larger research program that employs a standard research design across the range of mental and behavioral disorders to assess the impact and clinical utility of proposed changes in the ICD guidelines. Additional information about the rationale and experimental design for these studies has been published elsewhere .

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    Which Organization Sets The Standards For Diagnosing Eating Disorders

    Which Organization Sets The Standards For Diagnosing Eating Disorders. These symptoms will be outlined below to help you understand the different types of eating disorders, but we will revisit specific behaviours in more detail in subsequent. Eating disorders have the highest mortality rate of any mental illness.

    Eating disorders affect people of every age, race, size, gender identity, sexual orientation and background. Assessment | biopsychology | comparative | cognitive | developmental | language | individual differences | personality | philosophy | social | methods | statistics | clinical | educational | industrial | professional items | world psychology |. Eating disorders are among the most common psychiatric disorders in young women. Disordered eating, although also characterized as abnormal eating behavior, does not include all the criteria for diagnosing eating disorders and is therefore a way to recognize the problem in its early stages. The diagnoses of other specified feeding or eating disorders and unspecified feeding or eating disorders are new and replace the diagnosis of ednos.

    Diagnostic Criteria Is A Work In Progress

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    It’s important to note that the DSM is always, and always has been, a work in progress. There continue to be debates and disagreements among professionals about even the most current diagnostic criteria.

    However, the definitions included in the DSM do provide researchers and clinicians with a language for talking about and describing sets of symptoms many people are struggling with and that need treatment.

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