338 Feeding and Eating Disorders
be best made in the context of a clinical rela tionship over time. In some individuals, avoid-
ant/restrictive food intake disorder might precede the onset of anorexia nervosa.
Obsessive-compulsive disorder. Individuals with obsessive-compulsive disorder may
present with avoidance or restri ction of intake in relation to preoccupations with food or
ritualized eating behavior. Avoidant/restrictive  food intake disorder  should be diagnosed
concurrently only if all criteria are met for both disorders and when the aberrant eating is
a major aspect of the clinical presenta tion requiring specific intervention.
Major depressive disorder. In major depressive disorder, a ppetite might be affected to
such an extent that individuals present with significantly restricted food intake, usually in
relation to overall energy intake and often a ssociated with weight loss. Usually appetite
loss and related reduction of intake abate wi th resolution of mood problems. Avoidant/
restrictive food intake disorder should only be used concurrently if fu ll criteria are met for
both disorders and when the eating d isturbance requires specific treatment.
Schizophrenia spectrum disorders. Individuals with schizophrenia, delusional disor-
der, or other psychotic disorders may exhibit odd eating behaviors, avoidance of specific
foods because of delusional beliefs, or other ma nifestations of avoidant or restrictive in-
take. In some cases, delusional beliefs may contribute to a concern about negative conse-
quences of ingesting certain foods. Avoidant/r estrictive food intake disorder should be
used concurrently only if all criteria are me t for both disorders and when the eating dis-
turbance requires specific treatment.
Factitious disorder or factitious disorder imposed on another. Avoidant/restrictive
food intake disorder should be differentiated fr om factitious disorder or factitious disor-