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Eating Disorders & Anorexia Nervosa

Feeding and eating disorders The ICD‐11 grouping of feeding and eating disorders integrates ICD‐10 eating disorders and feeding disorders of childhood, in recognition of the interconnectedness of these disorders across the lifespan, as well as reflecting the evidence that these disorders can apply to individuals across a broader range of ages. The ICD‐11 provides updated conceptualizations of anorexia nervosa and bulimia nervosa to incorporate recent evidence, which eliminates the need for ICD‐10 “atypical” categories. It also includes the new entities of binge eating disorder, which is introduced based on empirical support for its validity and clinical utility, and ARFID, which expands upon ICD‐10 feeding disorder of infancy and childhood. Anorexia nervosa in the ICD‐11 eliminates the ICD‐10 requirement for the presence of a widespread endocrine disorder, because evidence suggests that this does not occur in all cases and, even when present, is a consequence of low body weight rather than a distinct defining feature of the disorder. Furthermore, cases without endocrine disorder were largely responsible for atypical anorexia diagnoses. The threshold for low body weight in ICD‐11 is raised from 17.5 kg/m2 to 18 kg/m2, but the guidelines accommodate situations in which the body mass index may not adequately reflect a worsening clinical picture (e.g., precipitous weight loss in the context of other features of the disorder). Anorexia nervosa does not require “fat phobia” as in the ICD‐10, to allow for the full spectrum of culturally diverse rationales for food refusal and expressions of body preoccupation. Qualifiers are provided to characterize the severity of underweight status, given that extremely low body mass index is associated with greater risk of morbidity and mortality. A qualifier describing the pattern of associated behaviours is included (i.e., restricting pattern, binge‐purge pattern). Bulimia nervosa in the ICD‐11 can be diagnosed regardless of the current weight of the individual, as long as the body mass index is not so low as to meet definitional requirements for anorexia nervosa. In lieu of specific minimal binge frequencies that are, in fact, not supported by evidence, the ICD‐11 provides more flexible guidance. A bulimia nervosa diagnosis does not require “objective” binges and can be diagnosed on the basis of “subjective” binges, in which the individual eats more or differently than usual and experiences a loss of control over eating accompanied by distress, regardless of the amount of food actually eaten. This change is expected to reduce the number of unspecified feeding and eating disorder diagnoses. #EatingDisorders #AnorexiaNervosa #icd11 #InternationalClassificationofDiseases