The American Psychiatric Association’s proposed diagnostic criteria for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) will include new recognition of binge eating disorder and minor changes in the criteria for anorexia nervosa and bulimia nervosa. Other recommended changes acknowledge that some eating disorders identified as beginning in infancy and childhood may also develop in older individuals.
DSM is the standard classification of mental disorders used by mental health and other health professionals for diagnostic and research purposes. The APA today released the proposed diagnostic criteria, which will be available for public comment until April 20. The proposed criteria will be reviewed and refined over the next two years. During this time, the APA will conduct three phases of field trials to test some of the proposed diagnostic criteria in real-world clinical settings.
“The extensive research in the field of eating disorders completed in the past few decades has improved our understanding of eating disorders and thus how better to diagnose them,” said David Kupfer, M.D., chair of the DSM-5 Task Force.
Binge eating disorder is characterized by recurring episodes of the consumption of unusually large amounts of food, accompanied by a sense of loss of control and strong feelings of embarrassment and guilt. The proposed criteria require that such episodes occur a minimum of once a week over the last three months. Binge eating disorder was described in the current version, DSM-IV, in an appendix, and there has since been substantial research leading the DSM- 5 Eating Disorders Work Group to believe that inclusion as a specific disorder within the revised manual is warranted.
“It is important that clinicians and the public be aware that there are substantial differences between an eating disorder such as binge eating disorder and the common phenomenon of overeating,” said B. Timothy Walsh, M.D., chair of the Eating Disorders Work Group. “While overeating is a challenge for many Americans, recurrent binge eating is much less common and far more severe and is associated with significant physical and psychological problems.”
Several eating disorders in DSM-IV are described in the section on Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence. These include pica (the ingestion of non-food substances such as dirt) and rumination disorder (regurgitation of food that is then re-chewed). Since it is now clear that these disorders may also develop later in life, the work group is recommending that the criteria be somewhat revised and included in the section on eating disorders in DSM-5.
The best known eating disorders are anorexia nervosa and bulimia nervosa. Anorexia nervosa primarily affects adolescent girls and young women; it is characterized by excessive dieting leading to severe weight loss accompanied by pathological fear of becoming fat and distorted body image. Bulimia nervosa is characterized by frequent episodes of binge eating followed by inappropriate behaviors such as self-induced vomiting to avoid weight gain.
Walsh explained that a major problem is that many individuals who seek treatment for an eating disorder do not meet DSM-IV criteria for these problems. In order to reduce the number of individuals whose symptoms are classified in the large and heterogeneous category “eating disorder not otherwise specified” in DSM-IV, the work group is recommending several changes to the existing criteria for anorexia nervosa and bulimia nervosa, as well as the recognition of binge eating disorder.
All proposed draft changes to DSM are being posted on the Web site www.DSM5.org for public review and comment until April 20. More information on the process for developing DSM-5 is also available on the Web site. Final publication of DSM-5 is planned for May 2013. “With the benefit of several decades of research and of information gleaned from clinical practice, we believe the ways to describe the problems of individuals with eating disorders can be significantly improved,” said Walsh.