psychology 101 class, 9wks tasks

be best made in the context of a clinical relationship over time. In some individuals, avoid­ ant/restrictive food intake disorder might precede the onset of anorexia nervosa. Obsessive-compulsive disorder. Individuals with obsessive-compulsive disorder may present with avoidance or restriction of intake in relation to preoccupations with food or ritualized eating behavior. Avoidant/restrictive food intake disorder should be diagnosed concurrently only if all criteria are met for both disorders and when the aberrant eating is a major aspect of the clinical presentation requiring specific intervention. Major depressive disorder. In major depressive disorder, appetite might be affected to such an extent that individuals present with significantly restricted food intake, usually in relation to overall energy intake and often associated with weight loss. Usually appetite loss and related reduction of intake abate with resolution of mood problems. Avoidant/ restrictive food intake disorder should only be used concurrently if full criteria are met for both disorders and when the eating disturbance requires specific treatment. Schizophrenia spectrum disorders. Individuals with schizophrenia, delusional disor­ der, or other psychotic disorders may exhibit odd eating behaviors, avoidance of specific foods because of delusional beliefs, or other manifestations of avoidant or restrictive in­ take. In some cases, delusional beliefs may contribute to a concern about negative conse­ quences of ingesting certain foods. Avoidant/restrictive food intake disorder should be used concurrently only if all criteria are met for both disorders and when the eating dis­ turbance requires specific treatment. Factitious disorder or factitious disorder imposed on another. Avoidant/restrictive food intake disorder should be differentiated from factitious disorder or factitious disor­ der imposed on another. In order to assume the sick role, some individuals with factitious disorder may intentionally describe diets that are much more restrictive than those they are actually able to consume, as well as complications of such behavior, such as a need for enteral feedings or nutritional supplements, an inability to tolerate a normal range of foods, and/or an inability to participate normally in age-appropriate situations involving food. The presentation may be impressively dramatic and engaging, and the symptoms re­ ported inconsistently. In factitious disorder imposed on another, the caregiver describes symptoms consistent with avoidant/restrictive food intake disorder and may induce physical symptoms such as failure to gain weight. As with any diagnosis of factitious dis­ order imposed on another, the caregiver receives the diagnosis rather than the affected in­ dividual, and diagnosis should be made only on the basis of a careful, comprehensive assessment of the affected individual, the caregiver, and their interaction.

Comorbidity The most commonly observed disorders comorbid with avoidant/restrictive food intake disorder are anxiety disorders, obsessive-compulsive disorder, and neurodevelopmental disorders (specifically autism spectrum disorder, attention-deficit/hyperactivity disor­ der, and intellectual disability [intellectual developmental disorder]).

Anorexia Nervosa Diagnostic Criteria A. Restriction of energy intal<e relative to requirements, leading to a significantly low body

weigfit in tfie context of age, sex, developmental trajectory, and physical health. Sig­ nificantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected.

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

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

Coding note: The ICD-9-CM code for anorexia nervosa is 307.1, which is assigned re­ gardless 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 re­ current episodes of binge eating or purging behavior (i.e., self-induced vomiting or the mis­ use of laxatives, diuretics, or enemas). This subtype describes presentations in which weight loss is accomplished primarily through dieting, fasting, and/or excessive exercise. (F50.02) B inge-eating/purging type: During the last 3 months, the individual has en­ gaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas).

Specify if: In partial remission: After full criteria for anorexia nervosa were previously met. Cri­ terion A (low body weight) has not been met for a sustained period, but either Criterion B (intense fear of gaining weight or becoming fat or behavior that interferes with weight gain) 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 of the 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) (see below) or, for children and adolescents, on BMI percentile. The ranges below are derived from World Health Organization categories for thinness in adults; for children and adoles­ cents, corresponding BMI percentiles should be used. The level of severity may be in­ creased to reflect clinical symptoms, the degree of functional disability, and the need for supervision.

Mild: BMI>17kg/m2 Moderate: BM116-16.99 kg/m^ Severe: BM115-15.99 kg/m^ Extreme: BMI < 15 kg/m^

Subtypes Most individuals with the binge-eating/purging type of anorexia nervosa who binge eat also purge through self-induced vomiting or the misuse of laxatives, diuretics, or enemas. Some individuals with this subtype of anorexia nervosa do not binge eat but do regularly purge after the consumption of small amounts of food.

Crossover between the subtypes over the course of the disorder is not uncommon; therefore, subtype description should be used to describe current symptoms rather than longitudinal course.

Diagnostic Features There are three essential features of anorexia nervosa: persistent energy intake restriction; intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain; and a disturbance in self-perceived weight or shape. The individual main­ tains a body weight that is below a minimally normal level for age, sex, developmental tra­ jectory, and physical health (Criterion A). Individuals' body weights frequently meet this criterion following a significant weight loss, but among children and adolescents, there may alternatively be failure to make expected weight gain or to maintain a normal devel­ opmental trajectory (i.e., while growing in height) instead of weight loss.