Meet Thy Monster

It’s not official, not yet.  It is, however, very exciting and encouraging news.

Since it was proposed in 2010, the American Psychiatric Association has considered adding {selective / fussy / resistant / adult picky eating / food neophobia} as a separate and new disorder to the Diagnostic and Statistical Manual of Mental Disorders.  Not only does the APA recognize that disordered eating, unrelated to body image, exists, but also agrees that providing diagnostic criteria, collecting statistics and offering options for treatment would be a lot easier if everyone used the same name.  Allow me to introduce the monster we dine with.

Avoidant/Restrictive Food Intake Disorder

It’s perhaps not as mysterious sounding as food neophobia, but the intent is not to wow an unsuspecting public with exotic sounding syllables.  If the APA called it Azuma or Zeek, I’d be just as happy.  A universally accepted name for a recognized condition means validation, relief, hope and a medical explanation for the limited diets of thousands of people.

“According to the APA, the name and criteria for diagnosis have been altered to reflect the fact that there are a number of types of presentations that occur across the age range rather than being restricted to infancy and early childhood.”

As a parent, I am overjoyed.  Finally, there is a clear distinction between “picky eating” as a temporary and brief part of normal toddler development and an eating disorder that often emerges around the same time and persists into adolescence and adulthood. Instead of being dismissed as something benign the child will outgrow, physicians will now have criteria to be able to recognize and diagnose feeding challenges in children much earlier.

“Most diagnoses in prior editions of the DSM had been validated only in adult populations and then applied with minor modifications to children and adolescents,” said Carl Feinstein, MD, professor of psychiatry and behavioral sciences at Stanford School of Medicine. “As a result, they didn’t fit children very well. Many children ended up with multiple diagnoses, and some children with serious problems didn’t fit any of the diagnostic categories. This made it much harder to select and prioritize treatment options.”

I never thought I would look forward to finding something in the Diagnostic and Statistical Manual of Mental Disorders that describes my child.  It’s not something I think we’ll add to his resume or boast about at the next family reunion.  It will come up in conversation.  I’m done accepting judgement from those who have never met our monster.  It’s time it came out from under the table and dressed for a formal dinner.

The proposed update from the American Psychiatric Association DSM-5 Development, as of May 14, 2012:

Avoidant/Restrictive Food Intake Disorder

A. Eating or feeding disturbance including but not limited to:

  • apparent lack of interest in eating or food;
  • avoidance based on the sensory characteristics of food or 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:

  • Significant weight loss (or failure to gain weight or faltering growth in children);
  • Significant nutritional deficiency;
  • Dependence on enteral feeding or nutritional supplements;
  • Marked interference with psychosocial functioning.

B. There is no evidence that lack of available food or an associated culturally sanctioned practice is sufficient to account for the disorder.

C. 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.

D. The eating disturbance is not better accounted for by a concurrent medical condition or another mental disorder. When occurring 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.

Stanford/Packard to test new diagnostic guidelines for pediatric and young adult mental disorders