Feeding and Eating Disorders

In the current psychiatric nomenclature of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) (American Psychiatric Association, 2013), the feeding and eating disorders category includes three previously defined eating disorder syndromes – anorexia nervosa, bulimia nervosa, and binge-eating disorder (BED) – and three conditions that were modified and moved from the section on Feeding and Eating Disorders of Infancy or Early Childhood in DSM-IV-TR (American Psychiatric Association, 2000) – pica, rumination disorder, and avoidant/restrictive food intake disorder (ARFID). These changes are also reflected in the most recent iteration of the International Classification of Diseases (11th ed., ICD-11; World Health Organization, 2020). While some significant differences in diagnostic criteria persist, the revisions made in both the DSM-5 and the ICD-11 represent an effort to move away from the use of “unspecified” or “not otherwise specified” eating disorder diagnoses. Obesity is not considered an eating disorder. Obesity refers to an excess of body fat and is viewed as a general medical, not a psychiatric, condition. Although there is increasing interest in the role of the brain in the development and persistence of obesity, at this stage of our knowledge obesity is perceived as an etiologically heterogeneous condition, influenced by cultural, environmental, and innate biological factors. It seems appropriate to describe as having an eating disorder only those obese individuals who manifest a clear behavioral abnormality that impairs health or psychosocial functioning (e.g., binge-eating disorder).