Feeding And Eating Disorders

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Feeding and Eating Disorder

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characterized by a persistent disturbance of eating or eating-related behavior that results in the altered consumption or absorption offood and that significantly impairs physical health or psychosocial functioning.

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PICA

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A. Persistent eating of nonnutritive, nonfood substances over a period of at least 1 month.

B. The eating of nonnutritive, nonfood substances is inappropriate to the developmentallevel of the individual.

C. The eating behavior is not part of a culturally supported or socially normative practice.

D. If the eating behavior occurs in the context of another mental disorder (e.g., intellectualdisability [intellectual developmental disorder], autism spectrum disorder, schizophrenia) or medical condition (including pregnancy), it is sufficiently severe to warrant additional clinical attention.

Coding note:

The ICD-9-CM code for pica is 307.52 and is used for children or adults.

The ICD-10-CM codes for pica are (F98.3) in children and (F50.8) in adults.

Specify if:

In remission: After full criteria for pica were previously met, the criteria have not beenmet for a sustained period of time.

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Feeding and Eating Disorder

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1. Pica disorders

2. Rumination disorder

3. Avoidant/restrictive food intake disorder

4. Anorexia Nervosa

5. Bulimia Nervosa

6. Binge Eating Disorder

7. Other specified feeding or eating disorder

8. Unspecified ...

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Rumination Disorder

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A. Repeated regurgitation of food over a period of at least 1 month. Regurgitated foodmay be re-chewed, re-swallowed, or spit out.

B. The repeated regurgitation is not attributable to an associated gastrointestinal or othermedical condition (e.g., gastroesophageal reflux, pyloric stenosis).

C. The eating disturbance does not occur exclusively during the course of anorexia nervosa,bulimia nervosa, binge-eating disorder, or avoidant/restrictive food intake disorder.

D. If the symptoms occur in the context of another mental disorder (e.g., intellectual disability [intellectual developmental disorder] or another neurodevelopmental disorder),they are sufficiently severe to warrant additional clinical attention.

Specify if:

In remission: After full criteria for rumination disorder were previously met, the criteriahave not been met for a sustained period of time.

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Avoidant/restrictive food intake

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A. An eating or feeding disturbance (e.g., apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food; concern about aversive consequences of eating) as manifested by persistent failure to meet appropriate nutritionaland/or energy needs associated with one (or more) of the following:

1. Significant weight loss (or failure to achieve expected weight gain or falteringgrowth in children).

2. Significant nutritional deficiency.

3. Dependence on enteral feeding or oral nutritional supplements.

4. Marked interference with psychosocial functioning.

B. The disturbance is not better explained by lack of available food or by an associatedculturally sanctioned practice.

C. 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 whichone’s body weight or shape is experienced.

D. The eating disturbance is not attributable to a concurrent medical condition or not better explained by another mental disorder. When the eating disturbance occurs in thecontext of another condition or disorder, the severity of the eating disturbance exceedsthat routinely associated with the condition or disorder and warrants additional clinicalattention.

Specify if:

In remission: After full criteria for avoidant/restrictive food intake disorder were previously met, the criteria have not been met for a sustained period of time.

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Anorexia Nervosa

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A. Restriction of energy intake relative to requirements, leading to a significantly low bodyweight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal or, forchildren and adolescents, less than that minimally expected.

B. Intense fear of gaining weight or of becoming fat, or persistent behavior that interfereswith weight gain, even though at a significantly low weight.

C. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition ofthe seriousness of the current low body weight.

Coding note: The ICD-9-CM code for anorexia nervosa is 307.1, which is assigned regardless of the subtype. The ICD-10-CM code depends on the subtype (see below).

Specify whether:(F50.01)

Restricting type: During the last 3 months, the individual has not engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas). This subtype describes presentations in whichweight loss is accomplished primarily through dieting, fasting, and/or excessive exercise.(F50.02)

Binge-eating/purging type: During the last 3 months, the individual has engaged in recurrent episodes of binge eating or purging behavior (i.e., self-inducedvomiting or the misuse of laxatives, diuretics, or enemas).

Specify if:

In partial remission: After full criteria for anorexia nervosa were previously met, Criterion A (low body weight) has not been met for a sustained period, but either CriterionB (intense fear of gaining weight or becoming fat or behavior that interferes with weightgain) or Criterion C (disturbances in self-perception of weight and shape) is still met.

In full remission: After full criteria for anorexia nervosa were previously met, none ofthe criteria have been met for a sustained period of time.

Specify current severity:

The minimum level of severity is based, for adults, on current body mass index (BMI) (seebelow) or, for children and adolescents, on BMI percentile. The ranges below are derivedfrom World Health Organization categories for thinness in adults; for children and adolescents, corresponding BMI percentiles should be used. The level of severity may be increased to reflect clinical symptoms, the degree of functional disability, and the need for supervision.

Mild: BMI ≥ 17 kg/m2

Moderate: BMI 16–16.99 kg/m2

Severe: BMI 15–15.99 kg/m2 Extreme: BMI < 15 kg/m2

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Bulimia Nervosa

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A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:

1. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most individuals would eat in a similar periodof time under similar circumstances.

2. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).

B. Recurrent inappropriate compensatory behaviors in order to prevent weight gain, suchas self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise.

C. The binge eating and inappropriate compensatory behaviors both occur, on average,at least once a week for 3 months.

D. Self-evaluation is unduly influenced by body shape and weight.

E. The disturbance does not occur exclusively during episodes of anorexia nervosa.

Specify if:

In partial remission: After full criteria for bulimia nervosa were previously met, some, but not all, of the criteria have been met for a sustained period of time.

In full remission: After full criteria for bulimia nervosa were previously met, none of the criteria have been met for a sustained period of time.

Specify current severity:

The minimum level of severity is based on the frequency of inappropriate compensatorybehaviors (see below). The level of severity may be increased to reflect other symptomsand the degree of functional disability.

Mild: An average of 1–3 episodes of inappropriate compensatory behaviors per week.

Moderate: An average of 4–7 episodes of inappropriate compensatory behaviors perweek.

Severe: An average of 8–13 episodes of inappropriate compensatory behaviors perweek.

Extreme: An average of 14 or more episodes of inappropriate compensatory behaviors per week.

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Binge-Eating Disorder

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A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:

1. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances.

2. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).

B. The binge-eating episodes are associated with three (or more) of the following:

1. Eating much more rapidly than normal.

2. Eating until feeling uncomfortably full.

3. Eating large amounts of food when not feeling physically hungry.

4. Eating alone because of feeling embarrassed by how much one is eating.

5. Feeling disgusted with oneself, depressed, or very guilty afterward.

C. Marked distress regarding binge eating is present.

D. The binge eating occurs, on average, at least once a week for 3 months.

E. The binge eating is not associated with the recurrent use of inappropriate compensatory behavior as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa.

Specify if: In partial remission: After full criteria for binge-eating disorder were previously met, binge eating occurs at an average frequency of less than one episode per week for a sustained period of time.

In full remission: After full criteria for binge-eating disorder were previously met, none of the criteria have been met for a sustained period of time.

Specify current severity: The minimum level of severity is based on the frequency of episodes of binge eating (see below). The level of severity may be increased to reflect other symptoms and the degree of functional disability.

Mild: 1–3 binge-eating episodes per week.

Moderate: 4–7 binge-eating episodes per week.

Severe: 8–13 binge-eating episodes per week.

Extreme: 14 or more binge-eating episodes per week.

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1. Atypical anorexia nervosa: All of the criteria for anorexia nervosa are met, exceptthat despite significant weight loss, the individual’s weight is within or above the normalrange.

2. Bulimia nervosa (of low frequency and/or limited duration): All of the criteria forbulimia nervosa are met, except that the binge eating and inappropriate compensatorybehaviors occur, on average, less than once a week and/or for less than 3 months.

3. Binge-eating disorder (of low frequency and/or limited duration): All of the criteriafor binge-eating disorder are met, except that the binge eating occurs, on average, lessthan once a week and/or for less than 3 months.

4. Purging disorder: Recurrent purging behavior to influence weight or shape (e.g., selfinduced vomiting; misuse of laxatives, diuretics, or other medications) in the absenceof binge eating

5. Night eating syndrome: Recurrent episodes of night eating, as manifested by eatingafter awakening from sleep or by excessive food consumption after the evening meal.There is awareness and recall of the eating. The night eating is not better explained byexternal influences such as changes in the individual’s sleep-wake cycle or by local social norms. The night eating causes significant distress and/or impairment in functioning. The disordered pattern of eating is not better explained by binge-eating disorderor another mental disorder, including substance use, and is not attributable to anothermedical disorder or to an effect of medication.

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Examples of presentations that can be specified using the “other specified” designationinclude the following: