DSM-5

● Bipolar and Related Disorder

● Depressive Disorder
● Anxiety Disorder
● OCD and Related Disorder
● Trauma and Stressor Related Disorder
● Dissociative Disorder
Schedule
● November 29- Eating Disorder/Elimination/
Sexual Dysfunction/Gender Dysphoria
(synchronous/asynchronous))
● Neurodevelopmental Disorder
● December 6- Neurodevelopmental Disorder-
(synchronous/asynchronous)
● December 13- Personality Disorder
(synchronous)
● Dec 20-
● Jan. 3 Schizophrenia and Psychotic Disorder
● Comprehensive Examination- January 2022
FEEDING AND EATING
DISORDER
FEEDING AND

EATING DISORDER

● disordersare characterized by a
persistent disturbance of eating or
eating-related behavior that results in
the altered consumption or absorption
of food and that significantly impairs
physical health or psychosocial
functioning.
● Pica
● Rumination disorder
● Avoidant/restrictive food intake
disorder
● Anorexia nervosa
● Bulimia nervosa
● Binge-eating disorder
PICA

PICA- described as persistent eating of

nonnutritive substances for at least 1 month.
EXAMPLES:
● Amylophagia (consumption of starch)
● Coprophagia (consumption of excrement)
● Geophagy (consumption of soil, clay, or chalk)
● Hematophagy (ingestion of blood)
● Hyalophagia (consumption of glass)
● Pagophagia (pathological consumption of ice)
● Self-cannibalism (rare condition where body parts may
be consumed)
● Trichophagia (consumption of hair or wool)
● Urophagia (consumption of urine)
● Xylophagia(consumptionofwood)

EPIDEMIOLOGY

● Rare among older children and

adolescents.
● Pica is more common among children
and adolescent with MR
● 15% with severe MR
● Affects both sexes
● Higher incidence in pica seems occur in the
relatives of persons with the symptoms.
● Nutritional deficiencies have been
postulated as causes of pica
● Those nutritionally deficient in iron or zinc
could elicit such particular cravings, though
the craving for non-food items generally fail
to replenish the mineral deficit in the body.
● Those dieting could try to lower hunger
pangs by consuming non-food items to
achieve a sense of being full.
SYMPTOMS

● Recurring ingestion of non-food items in

spite of endeavors at restricting it for
spans of a month or more.
● The behavior is deemed improper in case
of one’s kid’s age and developmental
phase (more than two years old).
● The behavior is not part of any culture,
ethnicity or devout practices.
DIFFERENTIAL DIAGNOSIS
● Iron and zinc deficiency
● Occurs in conjunction with failure to
thrive and several other mental
disorders
● Kleine-Levin syndrome, lead
intoxication,
DIAGNOSTIC CRITERIA
● Persistent eating of nonnutritive
substances for a period of at least 1 month.
● The eating of nonnutritive substances is
inappropriate to the developmental level.
● The eating behavior is not part of a
culturally sanctioned practice.
● If the eating behavior occurs exclusively
during the course of another mental
disorder (e.g.) Mental Retardation,
Pervasive Developmental Disorder,
Schizophrenia), it is sufficiently severe to
warrant independent clinical attention.
RUMINATION DISORDER

● RUMINATION DISORDER- is an
eating disorder in which a person
usually an infant or young child brings
back up and re-chews partially
digested food that has already been
swallowed
● Symptoms of rumination disorder
includes:

-Repeated regurgitation of food

-Repeated re-chewing of food

-Weight loss
● -Bad breath and tooth decay

-Repeated stomachaches and
indigestion

-Raw and chapped lips
● CAUSES
● The exact cause of rumination disorder is not
known; however, there are several factors that
may contribute to its development:
● -Physical illness or severe stress may trigger
the behavior

- Neglect of or an abnormal relationship
between the child and the mother or other
primary caregiver 

-may cause the child to engage in self-
comfort.
● DIAGNOSIS
● - If symptoms of rumination are present,
the doctor will begin an evaluation by
performing a complete medical history and
physical examination.
● DIAGNOSTIC CRITERIA FOR RUMINATION
DISORDER
● A. Repeated regurgitation of food over a period of at
least 1 month. Regurgitated food may be re-chewed, re-
swallowed, or spit out.
● B. There is no evidence that an associated
gastrointestinal or other general medical condition (for
example, gastroesophageal reflux) is sufficient to
account alone for the repeated regurgitation.
● C. The eating disturbance does not occur exclusively
during the course of Anorexia Nervosa, Bulimia Nervosa,
or Binge Eating Disorder, or Avoidant/Restrictive Food
Intake Disorder. 
● D. If the symptoms occur in the context of another
mental disorder (for example, Mental Retardation or a
Pervasive Developmental Disorder), they are sufficiently
severe to warrant independent clinical attention.
PROGNOSIS
● In many cases, rumination that begins
in infancy stops on its own. The disorder
should be treated, however, because
infants with untreated rumination disorder
are at risk of malnutrition and death
caused by dehydration.
Avoidant/Restrictive Food Intake
Disorder
A. An eating or feeding disturbance
(e.g., apparent lack of interest in
eating or food; avoidance based on
the sensory characteristics of food;
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:
● 1. Significant weight loss (or failure
to achieve expected weight gain or
faltering growth in children).
● 2. Significant nutritional deficiency.
● 3. Dependence on enteral feeding or
oral nutritional supplements.
● 4. Marked interference with
psychosocial functioning.
● B. The disturbance is not better
explained by lack of available food or
by an associated culturally sanctioned
practice.
● 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
attributable to a concurrent medical
condition or not better explained by
another mental disorder. When the
eating disturbance occurs 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.
● In some individuals, food avoidance or
restriction may be based on the sensory
characteristics of qualities of food, such as:
-extreme sensitivity to appearance
-color
-smell,
-texture
- temperature
- taste
● Such behavior has been described as:
-”restrictive eating,"
-"selective eating," "choosy eating,“
-"perseverant eating," "chronic food
refusal“
-"food neophobia"
 Anorexia nervosa

• Persons with this disorder may have an

intense fear of weight gain, even when
they are underweight. They may use
extreme dieting, excessive exercise, or
other methods to lose weight
• Weight less than 85% of expected
• Life threatening
• With amenorrhea for at least 3
consecutive cycles
Anorexia
nervosa
Sign and symptoms:
● Fear of gaining weight or becoming fat
● Body image disturbances
● Depressed mood, social withdrawal,
irritability, insomnia
● Feeling of ineffectiveness
● Complains of constipation and
abdominal pain
● Cold intolerance
● Electrolyte imbalance
 2 types:

● Restricting type- loses primarily through

dieting, fasting or excessive exercising

● Binge eating and purging type-

consumes a lot of food in a small period of
time then vomits .
● 10:1 FEMALE TO MALE RATIO
 Bulimia nervosa

• Recurrent episodes of binge eating followed

by inappropriate compensatory behaviors to
avoid weight gain.
• Binge eating usually secret
• Precipitated by strong emotions, followed by
guilt, remorse, shame or self-contempt
• Usually normal weight, or slightly overweight
or underweight.
• Begins in late adolescent or early adulthood.
o Patient is aware that eating behavior is
abnormal, and hides it from others
o Store food in cars, desks, secret
location inside the house.
A. Recurrent episodes of binge eating. An episode of
binge eating is characterized by

both of the following

● 1. Eating, in a discrete period of time

(e.g., within any 2-hour period), an
amount of food that is definitely larger
than what most individuals would eat in
a similar period of time under similar
circumstances.

● 2. A sense of lack of control over eating

during the episode (e.g., a feeling that
one cannot stop eating or control what
or how much one is eating).
● B. Recurrent inappropriate compensatory
behaviors in order to prevent weight gain,
such as self-induced vomiting; misuse of
laxatives, diuretics, or other medications;
fasting; or excessive exercise.

● C. The binge eating and inappropriate

compensatory behaviors both occur, on
average, at least once a week for 3 months.

● D. Self-evaluation is unduly influenced by

body shape and weight.

● E. The disturbance does not occur

exclusively during episodes of anorexia
nervosa
Bulimia
nervosa
Mild: An average of 1-3 episodes of inappropriate
compensatory behaviors per week.

Moderate: An average of 4-7 episodes of inappropriate

compensatory behaviors per
week.

Severe: An average of 8-13 episodes of inappropriate

compensatory behaviors per
week.

Extreme: An average of 14 or more episodes of

inappropriate compensatory behaviors
per week.
Binge-Eating Disorder
A. Recurrent episodes of binge eating. An episode
of binge eating is characterized by both of the
following:

1. Eating, in a discrete period of time (e.g., within

any 2-hour period), an amount of food that is
definitely larger than what most people would
eat in a similar period of time under similar
circumstances.

2. A sense of lack of control over eating during the

episode (e.g., a feeling that one cannot stop
eating or control what or how much one is
eating).
B. The binge-eating episodes are associated
with three (or more) of the following:
1. Eating much more rapidly than normal.
2. Eating until feeling uncomfortably full.
3. Eating large amounts of food when not
feeling physically hungry.
4. Eating alone because of feeling
embarrassed by how much one is eating.
5. Feeling disgusted with oneself,
depressed, or very guilty afterward.
C. Marked distress regarding binge
eating is present.
D. The binge eating occurs, on
average, at least once a week for 3
months.
E. The binge eating is not associated
with the recurrent use of
inappropriate compensatory
behavior as in bulimia nervosa and
does not occur exclusively during
the course of bulimia nervosa or
anorexia nervosa.
● THANKS! ☺

Let’s eat ☺
NEURODEVELOPMENTAL DISORDERS
1. Intellectual Disabilities
Intellectual Disability (Intellectual
Developmental Disorder)
Specify current severity;
Mild
Moderate
Severe
Profound
Global Developmental Delay
Unspecified Intellectual Disability
(Intellectual Developmental Disorder
2. Communication Disorders

Language Disorder
Speech Sound Disorder
Childhood-Onset Fluency Disorder
(Stuttering)
⦿ Note: Later-onset cases are diagnosed as
adult-onset fluency disorder.
Social (Pragmatic) Communication Disorder
Unspecified Communication Disorder
3. Autism Spectrum Disorder

Autism Spectrum Disorder

Specify if: Associated with a known medical or genetic
condition or environmental factor; Associated with
another neurodevelopmental, mental, or behavioral
disorder

Specify current severity for Criterion A and Criterion B:

Requiring very
substantial support. Requiring substantial support.
Requiring support
Specify if: With or without accompanying intellectual
impairment. With
or without accompanying language impairment.
4. Attention-Deficit/Hyperactivity Disorder

Attention-Deficit/Hyperactivity Disorder
Specify whether:
Combined presentation
Predominantly inattentive presentation
Predominantly hyperactive/impulsive presentation
Specify if: In partial remission
Specify current severity: Mild, Moderate, Severe
Other Specified Attention-Deficit/Hyperactivity
Disorder
Unspecified Attention-Deficit/Hyperactivity Disorder
5. Specific Learning Disorder

Specific Learning Disorder (66)

Specify if:
With impairment in reading {specify if with word reading
accuracy, reading rate or fluency, reading comprehension)
With impairment in written expression {specify if with
spelling accuracy, grammar and punctuation accuracy,
clarity or
organization of written expression
With impairment in mathematics {specify if with number
sense,
memorization of arithmetic facts, accurate or fluent
calculation, accurate math reasoning)
Specify current severity: Mild, Moderate, Severe
6. Motor Disorders
Developmental Coordination Disorder
Stereotypic Movement Disorder
Specify if: With self-injurious behavior.
Without self-injurious behavior
Specify if: Associated with a known medical or
genetic condition, neurodevelopmental
disorder, or environmental factor
Specify current severity: Mild, Moderate,
Severe
7. Tic Disorders
Tourette's Disorder
Persistent (Chronic) Motor or Vocal Tic
Disorder
Specify if: With motor tics only. With vocal tics
only
Provisional Tic Disorder (81)
Other Specified Tic Disorder (85)
Unspecified Tic Disorder (85)
8. Other Neurodevelopmental Disorders

Other Specified Neurodevelopmental Disorder

Unspecified Neurodevelopmental Disorder
NEURODEVELOPMENTAL DISORDER

⦿ Are a group of conditions with onset in the

developmental period.

⦿ Characterized by developmental deficits that

produce impairments of personal, social,
academic, or occupational functioning.
INTELLECTUAL DISABILITY

(INTELLECTUAL DEVELOPMENTAL DISORDER)

Diagnostic Criteria

Intellectual disability (intellectual

developmental disorder) is a disorder with
onset during the developmental period that
includes both intellectual and adaptive
functioning deficits in conceptual, social,
and practical domains. The following three
criteria must be met:
A. Deficits in intellectual functions, such as
reasoning, problem solving, planning,
abstract thinking, judgment, academic
learning, and learning from experience,
confirmed by both clinical assessment and
individualized standardized intelligence
testing.
\

B. Deficits in adaptive functioning that result

in failure to meet developmental and socio
cultural standards for personal
independence and social responsibility.
Without ongoing support, the adaptive
deficits limit functioning in one or more
activities of daily life, such as
communication, social participation, and
independent liv ing, across multiple
environments, such as home, school, work,
and community.
C. Onset of intellectual and adaptive deficits
during the developmental period
Specify if :
Mild
Moderate
Severe
Profound

Note: Specifiers

⦿ The various levels of severity are defined on the basis

of adaptive functioning, and not IQ scores, because it
is adaptive functioning that determines the level of
supports required. Moreover, IQ measures are less
valid in the lower end of the IQ range.
DIAGNOSTIC FEATURES

Criterion A refers to intellectual functions that

involve reasoning, problem solving, planning,
abstract thinking, judgment, learning from
instruction and experience, and practical
understanding.
Criterion B

Deficits in adaptive functioning refer to how

well a person meets community standards of
personal independence and social
responsibility, in comparison to others of
similar age and sociocultural background
Adaptive functioning involves adaptive
reasoning in three domains:

1. Conceptual
2. Social
3. Practical
⦿ The conceptual (academic) domain involves
competence in memory, language, reading,
writing, math reasoning, acquisition of
practical knowledge, problem solving, and
judgment in novel situations, among others

⦿ The social domain involves awareness of

others' thoughts, feelings, and experiences;
empathy; interpersonal communication skills;
friendship abilities; and social judgment,
among others.
⦿ The practical domain involves learning and
self-management across life settings,
including personal care, job responsibilities,
money management, recreation, self-
management of behavior, and school and
work task organization, among others.
⦿ Prevalence

⦿ Intellectual disability has an overall general

population prevalence of approximately 1%,
and prevalence rates vary by age. Prevalence
for severe intellectual disability is
approximately 6 per 1,000.
⦿ Gender-Related Diagnostic issues

⦿ Overall, males are more likely than females to be

diagnosed with both mild (average male: female
ratio 1.6:1)

⦿ severe (average male : female ratio 1.2:1) forms

of intellectual disability.

⦿ However, gender ratios vary widely in reported

studies. Sex-linked genetic factors and male
vulnerability to brain insult may account for some
of the gender differences
CO-MORBID
⦿ The most common co-occurring mental and
neurodevelopmental disorders are:

1. attention- deficit/hyperactivity disorder

2. depressive and bipolar disorders
3. anxiety disorders
4. autism spectrum disorder
5. stereotypic movement disorder (with or
without self-injurious behavior)
6. impulse-control disorders
7. major neurocognitive disorder
 GLOBAL DEVELOPMENTAL DELAY


⦿This diagnosis is reserved for individuals under

the age of 5 years when the clinical severity
level cannot be reliably assessed during early
childhood. This category is diagnosed when an
individual fails to meet expected
developmental milestones in several areas of
intellectual functioning, and applies to
individuals who are unable to undergo
systematic assessments of intellectual
functioning, including children who are too
young to participate in standardized testing.
This category requires reassessment after a
period of time.
 UNSPECIFIED INTELLECTUAL DISABILITY

(INTELLECTUAL DEVELOPMENTAL DISORDER)


⦿ This category is reserved for individuals over

the age of 5 years when assessment of the
degree of intellectual disability (intellectual
developmental disorder) by means of locally
available procedures is rendered difficult or
impossible because of associated sensory or
physical impairments, as in blindness or
prelingual deafness; locomotor disability; or
presence of severe problem behaviors or co-
occurring mental disorder. This category should
only be used in exceptional circumstances and
requires reassessment after a period of time.
SIGNS AND SYMPTOMS


○ The signs and symptoms of mental retardation

are all behavioral.
○ Children with mental retardation may learn to sit
up, to crawl, or to walk later than other children,
or they may learn to talk later.
○ Both adults and children with mental retardation
may also exhibit some or all of the following
characteristics:
1. Delays in oral language development
2. Deficits in memory skills
3. Difficulty learning social rules
4. Difficulty with problem solving skills
5. Delays in the development of adaptive behaviors
such as self-help or self-care skills
Mild 

About 85% of persons that
are intellectually disabled fall into this
group. IQ level 50-55 up to about 70

Moderate 

About 10% of persons that are intellectually
disabled fall into this group. 
○ IQ level 35-40 to 50-55
Severe

About 3% to 4%  
○ IQ level 20-25 to 35-40

Profound

About 1% to 2%
○ IQ level below 20 or 25
CAUSATION

1. Genetic conditions - These result from

abnormality of genes inherited from parents,
errors when genes combine, or from other
disorders of the genes caused during pregnancy
by infections, overexposure to x-rays and other
factors.
○ Inborn errors of metabolism which may produce
mental retardation:

1. PKU
2. DOWN SYNDROME

3. FRAGILE X

4. PRADER-WILLI
2. Problems during pregnancy - Use of alcohol or
drugs by the pregnant mother can cause mental
retardation.
3. Problems at birth - Although any birth condition
of unusual stress may injure the infant’s brain,
prematurity and low birth weight predict serious
problems more often than any other conditions.
4. Problems after birth - Childhood diseases such as
whooping cough, chicken pox, measles, which may
lead to meningitis and encephalitis can damage
the brain.

○ as can accidents such as a blow to the head or

near drowning. Substances such as lead and
mercury can cause irreparable damage to the
brain and nervous system.
5. Poverty and cultural deprivation - Children in
poor families may become mentally retarded
because of malnutrition, disease-producing
conditions, inadequate medical care and
environmental health hazards. Also, children in
disadvantaged areas may be deprived of many
common cultural and day- to-day experiences
provided to other youngsters.
PROGNOSIS

The outcome depends on:

○ Opportunities

○ Personal motivation

○ Treatment

○ Many people lead productive lives and function on

their own; others need a structured environment
to be most successful.
TREATMENT

○ The primary goal of treatment is to develop the

person's potential to the fullest. Special education
and training may begin as early as infancy. This
includes social skills to help the person function
as normally as possible.

○ It is important for a specialist to evaluate the

person for other affective disorders and treat
those disorders. Behavioral approaches are
important for people with mental retardation.
Thank you ☺