On December 1, 2012, an official communiqué was released by the American Psychiatric Association (APA) announcing that its Board of Trustees had approved the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5). The DSM is the manual that mental health professionals use to diagnose specific mental health disorders. The fourth edition of the manual was published in 1994, and the DSM-IV-TR (or DSM-IV, text revision) was published in 2000. According to the APA, the anticipated publication date for DSM-5 is spring of 2013. APA President Dilip Jeste, MD, said in a prepared statement that, “The Board of Trustees’ approval of the [diagnostic] criteria is a vote of confidence for the DSM-5.”
DSM-5 will bring about significant changes for eating disorders classification, which will inform research and treatment. One of the biggest modifications in DSM-5 is that binge eating disorder (BED) will join anorexia nervosa (AN) and bulimia nervosa (BN) as a bona fide eating disorder diagnosis. BED affects upwards of eight million men and women and is three times more prevalent than AN and BN combined. The core symptom of BED, like BN, is recurrent binge eating; however, unlike BN, there are no regular inappropriate compensatory behaviors (such as self-induced vomiting or laxative or diuretic abuse) present in BED. The binge eating episodes are characterized by eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances and experiencing a sense of lack of control over eating during the episode (i.e., feeling that one cannot stop eating or control what or how much one is eating).
The addition of BED as an official DSM-5 diagnosis falls on the heels of abundant research within the field advocating for its inclusion. In the past, individuals with BED have received a diagnosis of eating disorder not otherwise specified, or EDNOS. EDNOS was intended to be a residual diagnosis and yet, it has encompassed the majority of patients presenting for treatment. In the DSM-5, the heterogeneous EDNOS category will be replaced with “Feeding and Eating Conditions Not Elsewhere Classified,” or FECNEC. The FECNEC section will include descriptions of a number of informal disorders of clinical significance including purging disorder, night eating syndrome, atypical AN, subthreshold BN, and subthreshold BED.
In the past, a full syndrome DSM diagnosis has often been required for reimbursement for third party payers, which has prohibited some individuals with BED from receiving optimal care. The inclusion of BED as an official diagnosis in DSM-5 is predicted to decrease the overreliance on the catchall diagnostic category FECNEC, thereby increasing access to mental health services. In addition, adding BED as an official eating disorder diagnosis will also open doors for novel treatments and clinical trials specifically focusing on this disorder, which will be based on a uniformly accepted set of diagnostic criteria. A review of the literature examining the inclusion of BED in the DSM-5 can be found in the International Journal of Eating Disorders Special Section on DSM. http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1098-108X/homepage/dsm-v.htm).
As both treatment providers and research scientists, we at the UNC Center of Excellence for Eating Disorders are pleased with the addition of BED to DSM-5. This change represents a long-awaited advancement in eating disorders classification and a monumental accomplishment for eating disorder advocates who have fought tirelessly for individuals suffering from BED to have access to the services they deserve.
For more information about the DSM-5, BED, and eating disorder treatment please see:
http://www.dsm5.org/Pages/Default.aspx
http://www.aedweb.org/Eating_Disorders_Information.htm
http://www.nationaleatingdisorders.org/
By: Dr. Sara Trace
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