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.
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