Nevertheless, in DSM-5 there is no explanation on which mental disorders belong to which group, nor an explicit definition of each group. The decision to unite pica, RD, and ARFID with AN, BN, and BED in a single chapter named “Feeding and Eating Disorders” suggests that some of these conditions are feeding disorders (FDs), while some others are eating disorders (EDs). As for BN, the required minimum average frequency of binge eating was reduced from twice to once a week over the last 3 months. Third, BED-which in DSM-IV-TR was included in the Appendix, among conditions needing further studies-was officially recognized among FEDs as an independent category. Small changes were also made to the criteria for pica and RD, for clarification and for extending them to individuals of any age. The latter category, which was rarely used, has been renamed as ARFID and the diagnostic criteria have been expanded to include individuals of any age. Second, DSM-IV-TR categories of pica, RD, and feeding disorder of infancy or early childhood-previously included in the chapter describing disorders usually first diagnosed in infancy, childhood, or adolescence-were incorporated among FEDs. Footnote 2 The DSM-5 criteria thus include in the main diagnoses of AN and BN many patients previously classified as EDNOS (Caudle et al. First, the diagnostic criteria for AN and BN have been refined and expanded to decrease the number of people diagnosed in the DSM-IV-TR residual category of eating disorders not otherwise specified (EDNOS). The new classification has some important differences from the one included in DSM-IV-TR (Attia et al. The diagnostic criteria for RD, ARFID, AN, BN, and BED are construed as “mutually exclusive, so that during a single episode, only one of these diagnoses can be assigned” (American Psychiatric Association 2013a, 329). They are all included in a standalone chapter which comprises six independent disorders and two residual categories Footnote 1: pica, rumination disorder (RD), avoidant/restrictive food intake disorder (ARFID), anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), other specified feeding or eating disorder (OSFED), and unspecified feeding or eating disorder (UFED). In DSM-5, FEDs are “characterized by a persistent disturbance of eating or eating-related behavior that results in the altered consumption or absorption of food and that significantly impairs physical health or psychosocial functioning” (American Psychiatric Association 2013a, 329). Finally, I conclude with some considerations about the nature of FEDs. Next, I focus on the harm requirement, trying to unpack the two notions of distress and disability in the specific case of FEDs and to understand their role as diagnostic criteria. Then, I stress the importance of identifying the specific dysfunctions that underlie FEDs, as the definition of mental disorder demands, since the presence of certain symptoms alone is not sufficient to indicate a mental disorder. First, I briefly discuss the nosological history and the most relevant features of FEDs as well as the main requirements of the DSM-5 general definition of mental disorder. However, in the present context, I will not focus on these consequences. The question of whether or not FEDs can be regarded as mental disorders is conceptually interesting and important in its own right and it has practical and ethical consequences, too. Thus, I evaluate whether or not FEDs can reasonably be said to reflect a dysfunction and whether they are usually associated with distress or disability. In DSM-5 there is also an explicit statement saying that all mental disorders listed in the manual must meet the requirements highlighted by their general definition (American Psychiatric Association 2013a, 20). I focus my efforts in this analysis on clarifying one conceptual dimension of the overall FEDs debate by addressing only one specific question: Do FEDs fit the DSM-5 general definition of mental disorder? Or, to put it differently, are FEDs mental disorders in line with the DSM-5’s criteria? In DSM-5, a mental disorder is defined as a syndrome that reflects a dysfunction and is usually associated with significant distress or disability (American Psychiatric Association 2013a) thus, a mental disorder seems to be identified with a harmful dysfunction (Wakefield 1992). Now that the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has changed the overall classification and some specific criteria of FEDs, it is important to evaluate their psychiatric frameworks and their status as mental disorders. This paper aims at considering the conceptual status of feeding and eating disorders (FEDs).
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