![]() Several conceptual directions have been proposed for the ICD-11 2. Attention is paid to global cross-cultural validity and the needs of health professionals from medium and low income countries 1. Therefore, the primary requisite for ICD diagnostic categories is clinical utility, and evidence from clinical and epidemiological research is given more weight than data from basic and etiological research 1. The primary purpose of the International Classification of Diseases (ICD) is to facilitate the work of health professionals in various clinical settings across the world. THE INTERNATIONAL CLASSIFICATION OF DISEASES The purpose of this article is to summarize the issues in the classification of feeding and eating disorders, review relevant aspects of evidence, and make proposals for modifications in the context of the development of ICD-11. A number of proposals for changes have been made. Given these problems, it is not surprising that the World Health Organization (WHO) and the American Psychiatric Association are contemplating significant changes in classification. Issues have also been raised about developmental and cultural dependencies of feeding and eating disorders as currently conceptualized. Fourth, although childhood feeding disorders are typically described in the history of adolescents and adults with eating disorders, there is little research on the developmental continuity between childhood, adolescent and adult disorders that involve aberrant eating behaviours. ![]() Third, most recent clinical trials have used modified diagnostic criteria that may better reflect clinical practice, but deny the purpose of the classification as a means for communication between clinicians and researchers. Second, most individuals with an eating disorder sequentially receive several diagnoses instead of a single diagnosis that would describe the individual’s problems at various developmental stages. First, the majority of patients presenting with eating-related psychopathology do not fulfil criteria for a specific disorder and are classified in the residual “other” or “not otherwise specified” categories. The deficiencies of these systems are most evident in four facts. The classification of feeding and eating disorders in the ICD-10 and DSM-IV is unsatisfactory. ![]() We make the following recommendations: a) feeding and eating disorders should be merged into a single grouping with categories applicable across age groups b) the category of anorexia nervosa should be broadened through dropping the requirement for amenorrhoea, extending the weight criterion to any significant underweight, and extending the cognitive criterion to include developmentally and culturally relevant presentations c) a severity qualifier “with dangerously low body weight” should distinguish the severe cases of anorexia nervosa that carry the riskiest prognosis d) bulimia nervosa should be extended to include subjective binge eating e) binge eating disorder should be included as a specific category defined by subjective or objective binge eating in the absence of regular compensatory behaviour f) combined eating disorder should classify subjects who sequentially or concurrently fulfil criteria for both anorexia and bulimia nervosa g) avoidant/restrictive food intake disorder should classify restricted food intake in children or adults that is not accompanied by body weight and shape related psychopathology h) a uniform minimum duration criterion of four weeks should apply. ![]() We review evidence on the developmental and cross-cultural differences and continuities, course and distinctive features of feeding and eating disorders. Classification of feeding and eating disorders in ICD-11 requires substantial changes to remediate the shortcomings. The classification is divorced from clinical practice, and investigators of clinical trials have felt compelled to introduce unsystematic modifications. Current classification of eating disorders is failing to classify most clinical presentations ignores continuities between child, adolescent and adult manifestations and requires frequent changes of diagnosis to accommodate the natural course of these disorders. ![]()
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