Classification of eating disturbance in children and adolescents: Proposed changes for the DSM‐V

Abstract

Childhood and adolescence are critical periods of neural development and physical growth. The malnutrition and related medical complications resulting from eating disorders such as anorexia nervosa (AN), bulimia nervosa (BN) and eating disorder not otherwise specified may have more severe and potentially more protracted consequences during youth than during other age periods. The consensus opinion of an international workgroup of experts on the diagnosis and treatment of child and adolescent eating disorders is that (a) lower and more developmentally sensitive thresholds of symptom severity (e.g. lower frequency of purging behaviours, significant deviations from growth curves as indicators of clinical severity) be used as diagnostic boundaries for children and adolescents, (b) behavioural indicators of psychological features of eating disorders be considered even in the absence of direct self-report of such symptoms and (c) multiple informants (e.g. parents) be used to ascertain symptom profiles. Collectively, these recommendations will permit earlier identification and intervention to prevent the exacerbation of eating disorder symptoms.

Eating Disorders in Children and Adolescents: State of the Art Review

“…In addition, behavioral criteria are considered equivalent to cognitive criteria, equating fear of weight gain to failure to gain weight in the face of low body weight or growth stunting. 5 Amenorrhea has been removed as a criterion because its use was never validated 36 and excluded males, premenarchal females, and adolescents who remain eumenorrheic despite low body weight. 37 Finally, body image distortion or an unusual focus on weight or shape are still included as The distinguishing feature between BED and BN is that episodes of binge eating are not associated with inappropriate compensatory behaviors.…”

“…Pubertal milestones such as linear growth or menstrual cycles are often affected. 5,16,24 DSM-5 criteria for AN consider expected weight and growth 36 in children and adolescents versus comparisons to population norms. They describe a restriction of energy intake relative to requirements, leading to a lower than expected body weight.…”

Attitudes Toward Overweight and Their Association With Risk of Eating Disorder in Children. An Exploratory Study

“…No se con-firmó la presencia del cuadro clínico tal y como se describe en los manuales diagnósticos como el DSM-IV (APA, 2002) y la CIE-10 (OMS, 1992), dado que estos no son apropiados para diagnosticar trastornos alimentarios en niños de estas edades (Nicholls, Chater y Lask, 2000). Para considerar la confirmación del riesgo se tuvieron en cuenta los criterios Great Ormond Street (GOS) propuestos por Lask y Bryant-waugh (2000) y los cambios propuestos para el DSM-V por el grupo de trabajo para la clasificación de trastornos alimentarios en niños y adolescentes (workgroup for Classification of Eating Disorders in Children and Adolescent, Bravender et al, 2010). Dichos criterios establecen:…”

Anorexia nervosa through the looking glass of the draft ICD-11 diagnostic criteria: a disorder in transition

“…This change mostly stemmed from evidence that a substantial proportion of patients with anorexia nervosa do not endorse fear of gaining weight/fatness. In particular, there is evidence that non-Western and younger presentations are less likely to express fear of gaining weight/fatness [18,3]. This shift is therefore particularly important for children and young adolescents.…”