Other Disordered Eating Patterns

PICA

1. Persistent eating of nonnutritive, nonfood substances (such as paper, wood and soil) over the period of at least 1 month. 
2. The eating of nonnutritive, nonfood substances the inappropriate to the developmental level of the individual. 
3. The eating behaviour is not part of a culturally supported or socially normative practice. 
4. If the eating behaviour occurs in the context of another mental disorder (e.g. intellectual disability, autism spectrum disorder) or medical condition (e.g. pregnancy), it is sufficiently severe to warrant additional clinical attention

Rumination Disorder 

1. Repeated regurgitation of food over the period of at least one month. Regurgitated food may be re-chewed, re-swallowed, or spit out. 
2. Not attributable to an associated gastrointestinal or other medical condition (e.g. reflux). 
3. Does not occur exclusively during the course of anorexia nervosa, bulimia nervosa, binge-eating disorder, or avoidant/restrictive food intake disorder. 
4. If symptoms occur in the context of another mental disorder (e.g. intellectual disability), they are sufficiently severe to warrant additional clinical attention. 

Avoidant/Restrictive Food Intake Disorder 

1. A feeding or eating disturbance (e.g. lack of apparent interest in eating food; avoidance based on the sensory characteristics of food; concern about aversive consequences of eating)as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one (or more) of the following:
   1. Significant weight loss (or failure to achieve expected weight gain or faltering growth in children). 
   2. Significant nutritional deficiency. 
   3. Dependence on enteral feeding or oral nutritional supplements. 
   4. Marked interference with psychosocial functioning. 
2. The disturbance is not better explained by lack of available food or by an associated culturally sanctioned practice. 
3. 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 which one’s body weight or shape is experienced. 
4. 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 the context of another condition or disorder, the severity of the eating disturbance exceeds that routinely associated with the condition or disorder and warrants additional clinical attention.

Binge-Eating Disorder 

1. Recurrent episodes of binge eating. An episode of binge eating is characterized by both: 

• 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 period of time under similar circumstances; 
• A sense of lack of control over eating during the episodes (e.g. a feeling that one cannot stop eating or control what or how much one is eating). 

2. Binge eating episodes are associated with three or more of the following: 

• Eating much more rapidly than normal. 
• Eating until feeling uncomfortably full. 
• Eating large amounts of food when not feeling physically hungry. 
• Eating alone because of feeling embarrassed by how much one is eating. 
• Feeling disgusted with oneself, depressed, or very guilty afterwards. 

3. Marked distress regarding binge eating is present. 
4. The binge eating occurs, on average, at least once a week for 3 months. 
5. 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. 
6. Specify current severity: 

• 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.