PDF(Pubmed)
Abstract：
The eating and feeding disorder section of the Diagnostic and Statistical Manual of Mental Disorders 5 Text Revision (DSM-5-TR) is organized by a diagnostic algorithm that limits the contemporaneous assignment of multiple eating disorder diagnoses. Avoidant/restrictive food intake disorder (ARFID) is a disturbance in food intake typically associated with lack of interest in food, food avoidance based on sensory characteristics, and/or fear of aversive consequences from eating. According to the DSM-5-TR, an ARFID diagnosis cannot be made when weight or shape disturbances are present, and ARFID cannot be co-diagnosed with other eating disorders characterized by these disturbances. However, emerging evidence from both clinical and lived experience contexts suggests that the co-occurrence of ARFID with multiple other types of eating disorders may be problematically invisibilized by this trumping scheme. The diagnostic criteria for ARFID can contribute to inappropriate diagnosis or exclusion from diagnosis due to excessive ambiguity and disqualification based on body image disturbance and other eating disorder pathology, even if unrelated to the food restriction or avoidance. This harmfully limits the ability of diagnostic codes to accurately describe an individual\'s eating disorder symptomatology, impacting access to specialized and appropriate eating disorder care. Therefore, revision of the DSM-5-TR criteria for ARFID and removal of limitations on the diagnosis of ARFID concurrent to other full-syndrome eating disorders stands to improve identification, diagnosis, and support of the full spectrum of ARFID presentations.
摘要：
精神疾病诊断和统计手册5文本修订（DSM-5-TR）的饮食和喂养障碍部分是通过诊断算法组织的，该算法限制了多种饮食障碍诊断的同时分配。回避/限制性食物摄入障碍（ARFID）是一种食物摄入障碍，通常与对食物缺乏兴趣有关。基于感官特征的食物回避，和/或担心吃东西会带来令人厌恶的后果。根据DSM-5-TR，当存在重量或形状干扰时，无法进行ARFID诊断，并且ARFID不能与以这些紊乱为特征的其他进食障碍共同诊断。然而,来自临床和生活经验背景的新证据表明，ARFID与多种其他类型的饮食失调的同时发生可能会被这种优先方案所掩盖。ARFID的诊断标准可能导致不恰当的诊断或由于过度模糊和基于身体图像障碍和其他进食障碍病理的不合格而被排除在诊断之外。即使与食物限制或避免无关。这有害地限制了诊断代码准确描述个体饮食失调症状的能力，影响获得专门和适当的饮食失调护理。因此,修订ARFID的DSM-5-TR标准，并消除对ARFID的诊断与其他全面综合征饮食失调并存的限制，以提高识别能力。诊断,并支持ARFID演示的全部范围。
