The diagnostic criteria for rumination disorder, avoidant/restrictive food intake dis- order, anorexia nervosa, bulimia nervosa, and binge-eating disorder result in a classifica- tion scheme that is mutually exclusive, so that during a single episode, only one of these diagnoses can be assigned. The rationale for this approach is that, despite a number of common psychological and behavioral features, the disorders differ substantially in clin- ical course, outcome, and treatment needs. A diagnosis of pica, however, may be assigned in the presence of any other feeding and eating disorder.
Some individuals with disorders described in this chapter report eating-related symp- toms resembling those typically endorsed by individuals with substance use disorders, such as craving and patterns of compulsive use. This resemblance may reﬂect the involve- ment of the same neural systems, including those implicated in regulatory self-control and reward, in both groups of disorders. However, the relative contributions of shared and distinct factors in the development and perpetuation of eating and substance use disor- ders remain insufficiently understood.
Finally, obesity is not included in DSM-5 as a mental disorder. Obesity (excess body fat) results from the long—term excess of energy intake relative to energy expenditure. A range of genetic, physiological, behavioral, and environmental factors that vary across individ- uals contributes to the development of obesity; thus, obesity is not considered a mental disorder. However, there are robust associations between obesity and a number of mental disorders (e.g., binge-eating disorder, depressive and bipolar disorders, schizophrenia).
The side effects of some psychotropic medications contribute importantly to the develop- ment of obesity, and obesity may be a risk factor for the development of some mental dis- orders (e.g., depressive disorders).
A. Persistent eating of nonnutritive, nonfood substances over a period of at least 1 month.
B. The eating of nonnutritive, nontood substances is inappropriate to the developmental level of the individual.
. The eating behavior is not part of a culturally supported or socially normative practice.
. If the eating behavior occurs in the context of another mental disorder (e.g., intellectual disability [intellectual developmental disorder], autism spectrum disorder, schizophre- nia) or medical condition (including pregnancy), it is sufficiently severe to warrant ad- ditional clinical attention.
Coding note: The |CD-9-CM code for pica is 307.52 and is used for children or adults.
The ICD-10-CM codes for pica are (F98.3) in children and (F50.8) in adults.
Specify it:
In remission: After full criteria for pica were previously met. the criteria have not been met for a sustained period of time.