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The fifth edition of the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-5) renamed "Feeding Disorder of Infancy or Early Childhood" to Avoidant/Restrictive Food Intake Disorder, and broadened the diagnostic criteria. Previously defined as a disorder exclusive to children and adolescents, the DSM-5 broadened the disorder to include adults who limit their eating and are affected by related physiological or psychological problems, but who do not fall under the definition of another eating disorder.
The DSM-5 defines the following diagnostic criteria:
- Disturbance in eating or feeding, as evidenced by one or more of:
- Substantial weight loss (or, in children, absence of expected weight gain)
- Nutritional deficiency
- Dependence on a feeding tube or dietary supplements
- Significant psychosocial interference
- Disturbance not due to unavailability of food, or to observation of cultural norms
- Disturbance not due to anorexia nervosa or bulimia nervosa, and no evidence of disturbance in experience of body shape or weight
- Disturbance not better explained by another medical condition or mental disorder, or when occurring concurrently with another condition, the disturbance exceeds what is normally caused by that condition
In previous years, the DSM was not inclusive in recognizing all of the challenges associated with feeding and eating disorders in 3 main domains:
- Eating Disorders Not Otherwise Specified (EDNOS) was an all-inclusive, placeholder group for all individuals that presented challenges with feeding
- The category of Feeding Disorder of Infancy/ Early Childhood was noted to be too broad, limiting specification when treating these behaviors
- There are children and youth who present feeding challenges but do not fit within any existing categories to date
Children are often picky eaters, this does not necessarily mean they meet the criteria for an ARFID diagnosis. In addition, self-identification as having ARFID may contribute to ARFID.
Sufferers of ARFID have an inability to eat certain foods. "Safe" foods may be limited to certain food types and even specific brands. In some cases, afflicted individuals will exclude whole food groups, such as fruits or vegetables. Sometimes excluded foods can be refused based on color. Some may only like very hot or very cold foods, very crunchy or hard-to-chew foods, or very soft foods, or avoid sauces.
Most sufferers of ARFID will still maintain a healthy or normal body weight. There are no specific outward appearances associated with ARFID. Sufferers can experience physical gastrointestinal reactions to adverse foods such as retching, vomiting or gagging. Some studies have identified symptoms of social avoidance due to their eating habits. Most, however, would change their eating habits if they could.
The five OSFED examples that can be considered eating disorders include atypical AN, BN (of low frequency and/or limited duration), BED (of low frequency and/or limited duration), purging disorder, and NES. Of note, OSFED is not limited to these five examples, and can include individuals with heterogeneous eating disorder presentations (i.e., OSFED-other). Another term, Unspecified Feeding or Eating Disorder (UFED), is used to describe individuals for whom full diagnostic criteria are not met but the reason remains unspecified or the clinician does not have adequate information to make a more definitive diagnosis.
- Atypical Anorexia Nervosa: In atypical AN, individuals meet all of the criteria for AN, with the exception of the weight criterion: the individual's weight remains within or above the normal range, despite significant weight loss.
- Atypical Bulimia Nervosa: In this sub-threshold version of BN, individuals meet all criteria for BN, with the exception of the frequency criterion: binge eating and inappropriate compensatory behaviors occur, on average, less than once a week and/or for fewer than 3 months.
- Binge-eating disorder (of low frequency and/or limited duration): In this sub-threshold version of BED, individuals must meet all criteria for BED, with the exception of the frequency criterion: binge eating occurs, on average, less than once a week and/or for fewer than 3 months.
- Purging Disorder: In purging disorder, purging behavior aimed to influence weight or shape is present, but in the absence of binge eating.
- Night Eating Syndrome: In NES, individuals have recurrent episodes of eating at night, such as eating after awakening from sleep or excess calorie intake after the evening meal. This eating behavior is not culturally acceptable by group norms, such as the occasional late-night munchies after a gathering. NES includes an awareness and recall of the eating, is not better explained by external influences such as changes in the individual's sleep-wake cycle, and causes significant distress and/or impairment of functioning. Though not defined specifically in "DSM-5", research criteria for this diagnosis proposed adding the following criteria (1) the consumption of at least 25% of daily caloric intake after the evening meal and/or (2) evening awakenings with ingestions at least twice per week.
Other specified feeding or eating disorder or OSFED is the "DSM-5" category that replaces the category formerly called Eating Disorder Not Otherwise Specified (EDNOS) in "DSM-IV", and that captures feeding disorders and eating disorders of clinical severity that do not meet diagnostic criteria for anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), avoidant/restrictive food intake disorder (ARFID), pica, or rumination disorder. OSFED includes five examples: atypical AN, BN (of low frequency and/or limited duration), BED (of low frequency and/or limited duration), purging disorder, and night eating syndrome (NES).
The root word for emetophobia is "emesis", from the Greek word "emein" which means "an act or instance of vomiting" with "-phobia” meaning "an exaggerated usually inexplicable fear of a particular object, class of objects, or situation."
People with emetophobia frequently report a vomit related traumatic event, such as a long bout of stomach flu, accidentally vomiting in public, or having to witness someone else vomit, as the start of the emetophobia. They may also be afraid of hearing that someone is feeling like vomiting or that someone has vomited, usually in conjunction with the fears of seeing someone vomit or seeing vomit.
Emetophobia is a phobia that causes overwhelming, intense anxiety pertaining to vomiting. This specific phobia can also include subcategories of what causes the anxiety, including a fear of vomiting in public, a fear of seeing vomit, a fear of watching the action of vomiting or fear of being nauseated. It is common for emetophobics to be underweight, or even anorexic, due to strict diets and restrictions they make for themselves. The thought of someone possibly vomiting can cause the phobic person to engage in extreme behaviors to escape the perceived (and sometimes very real) threat of that particular situation, in which the phobic person will go to great lengths to avoid even potential situations that could even be perceived as "threatening".
Emetophobia is clinically considered an "elusive predicament" because limited research has been done pertaining to it. The fear of vomiting receives little attention compared with other irrational fears. Emetophobia is not limited by age or maturity level. There are cases of emetophobia present in childhood and adolescence, as well as adulthood.
The event of vomiting may scare away anyone with this peculiar phobia. Some may fear someone throwing up while another may fear themselves throwing up. Some may have both.
Some may have anxiety which makes them feel like they will throw up when it actually might not. People with Emetophobia usually suffer from anxiety, they often scream or cry when someone or something has been sick.