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NEDA TOOLKIT for Coaches and Trainers Avoidant Restrictive Food Intake Disorder (ARFID) is defined by the following criteria: • An eating or feeding disturbance as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one (or more) of the following: Significant loss of weight (or failure to achieve expected weight gain or faltering growth in children) Significant nutritional deficiency Dependence on enteral feeding or oral nutritional supplements Marked interference with psychosocial functioning • The behavior is not better explained by lack of available food or by an associated culturally sanctioned practice. • The behavior does not occur exclusively during the course of anorexia nervosa or bulimia nervosa, and there is no evidence of a disturbance in the way one’s body weight or shape is experienced. The eating disturbance is not attributed to a medical condition or better explained by another mental health disorder. When it does occur in the presence of another condition/ disorder, the behavior exceeds what is usually associated with the condition, and warrants additional clinical attention. Other Specified Feeding or Eating Disorder (OSFED), formerly known as Eating Disorder Not Otherwise Specified (EDNOS), is a term used in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders to describe feeding or eating behaviors that cause clinically significant distress and impairment in areas of functioning, but do not meet the full criteria for any of the other feeding and eating disorders. A diagnosis might then be allocated that cites a specific reason why the presentation does not meet the criteria of another disorder (e.g., bulimia nervosa – low frequency). The following are further examples of OSFED: • Atypical Anorexia Nervosa:  All criteria are met, except despite significant weight loss, the individual’s weight is within or above the normal range. • Binge Eating Disorder (of low frequency and/ or limited duration):  All of the criteria for BED are met, except at a lower frequency and/or for less than three months. • Bulimia Nervosa (of low frequency and/or limited duration):  All of the criteria for bulimia nervosa are met, except that the binge eating and inappropriate compensatory behavior occurs at a lower frequency and/or for less than three months. • Purging Disorder:  Recurrent purging behavior to influence weight or shape in the absence of binge eating • Night Eating Syndrome:  Recurrent episodes of night eating. Eating after awakening from sleep, or excessive food consumption after the evening meal. The behavior is not better explained by environmental influences or social norms. The behavior causes significant distress/impairment. The behavior is not better explained by another mental health disorder (e.g., BED). In addition, there are some unofficial terms, some of which have been popularized by the media, which are sometimes used in the sports community: • Anorexia athletica:  a term used for a sub- group of athletes with eating disorder symptoms that do not permit a diagnosis of anorexia nervosa or bulimia nervosa, and would therefore fall within OSFED. • Orthorexia nervosa:  a term used to describe individuals who take their concerns about eating “healthy” foods to dangerous and/or obsessive extremes. • Diabulimia:  the manipulation of insulin by diabetics for the purpose of losing weight. • Drunkorexia:  self-imposed starvation or bingeing and purging, combined with alcohol abuse. While anorexia nervosa and bulimia nervosa are terms most people have heard of, there is a growing body of research that points to the destructive consequences of disordered eating. An athlete may not meet the criteria for full-blown anorexia nervosa or bulimia nervosa, but his/her habits and patterns can negatively affect performance, team dynamics, and health. Page  | 6