TPC-Journal-V4-Issue3

The Professional Counselor \Volume 4, Issue 3 248 one diagnosis (Dailey et al., 2014). The feeding and eating disorders diagnostic criteria are mutually exclusive, meaning that if a client is diagnosed with one disorder in this chapter, the client cannot be diagnosed with another (with pica as the only exception). The DSM-5 wants to ensure differentiation of each disorder and help counselors plan treatment that targets the unique features of a disorder (APA, 2013a). See Table 1 for a review of DSM-IV-TR and DSM-5 classification of eating disorders. Table 1 Past and Current Feeding and Eating Disorder Diagnoses DSM- IV-TR DSM-5 Pica Pica Rumination Disorder Rumination Disorder Feeding Disorder of Infancy or Early Childhood Avoidant/Restrictive Food Intake Disorder Anorexia Nervosa Anorexia Nervosa Bulimia Nervosa Bulimia Nervosa Binge-Eating Disorder Eating Disorder Not Otherwise Specified (EDNOS) Other Specified Feeding or Eating Disorder Unspecified Feeding or Eating Disorder Specific Changes to Eating Disorder Diagnoses Pica and Rumination Disorder Pica and rumination disorder are two eating disorders that often receive less clinical attention from counselors than other eating disorders. This is probably due to the fact that these disorders are likely to be observed in institutionalized settings, and that treatment may necessitate the expertise of behavioral analysts or therapists highly trained in working with developmental disabilities (Williams & McAdam, 2012). Only the locations of pica and rumination have changed in the DSM-5 : These disorders now appear in the chapter on feeding and eating disorders. With this change, these diagnoses are now applicable to individuals across the life span. The criteria for these disorders did not change. Pica is the ingestion of non-nutritive substances (e.g., hair, chalk, paint chips) over at least a one-month period. Availability and the age of the affected individual often determine what substances a person will consume (Hartmann et al., 2012). Some reports have included individuals eating paper, tissues, wood, metal, small rocks, carpet and soap (Matson, Belva, Hattier, & Matson, 2011). The eating of these non-food substances is deemed to be inappropriate to the developmental level of the individual and is not part of a cultural or socially accepted practice (APA, 2013a). Generally, clinicians see this disorder in children with intellectual disabilities (Mash & Wolfe, 2013). However, the fourth criterion of the diagnosis notes that if this condition does occur within the context of a developmental or intellectual disability, it should be sufficiently severe to warrant clinical attention. Children with pica eat normal foods as well as non-nutritive foods. In most cases, the disorder remits on its own, or will cease with improved environmental conditions or added infant stimulation (Mash & Wolfe, 2013). One common thought is that this disorder presents in children who do not have sufficiently stimulating environments. Hartmann et al. (2012) reported that some clinicians regard pica as a form of self-soothing behavior, employed when one’s arousal reaches a certain level. However, for children with intellectual