The DSM V and Eating Disorders

Psychiatry, and by extension all mental health fields, are to some degree reliant on the Diagnostic Statistical Manual of the American Psychiatric Association. This manual, currently in its 4th addition, is now being re-evaluated for the upcoming 5th edition, known as the DSM V. The DSM is critical in multiple areas of mental healthcare. Its primary function is to provide a behavioral basis for diagnosis. In doing so, it provides standards by which a diagnosis can be reasonably made, that are considered valid and useful for the patient who is receiving the diagnosis.

The core feature of effective healthcare is the ability to link various treatments to different diagnoses. One of the most important ways to determine if you are receiving effective care is to know that your diagnosis impacts your treatment. A provider who believes one treatment treats all is unlikely to be providing effective care. In developing the DSM V, the American Psychiatric Association is acknowledging the importance of supporting the need for accurate diagnosis and effective treatment based on that diagnosis.

The process of developing accurate diagnoses is complicated. Early DSM versions are primarily informed by a psychodynamic view of the world and are not behaviorally organized. Starting with the DSM III in 1975, greater emphasis has been placed on behaviors and their treatment. The DSM V will be the most recent attempt to be as specific and clear as possible about true diagnostic categories and how best to understand complex psychological presentations. It is the nature of these diagnoses and definitions that they will not be perfect, final, or complete and that modifications will continue to occur. However, each manual has been an improvement of its predecessor and we believe the DSM V will be as well.

For eating disorders, there are some significant changes proposed for the DSM V. These include:

  • The addition of Binge Eating Disorder as separate diagnosis. At this time, Binge Eating Disorder falls under the diagnosis of a non-specified eating disorder. Binge Eating Disorder, however, is likely the most common eating disorder, has significant medical complications, and may have effective behavioral treatment. Thus, patients will benefit by its having its own separate diagnostic category.
  • The diagnosis for Anorexia Nervosa has been changed with the removal of the criteria for amenorrhea. This particular criteria has historically been used for research but is not considered to be a specific marker for the illness and it is possible to have anorexia while still having a normal menses. Its removal therefore will enable more patients to receive effective care.
  • Bulimia Nervosa has been changed so that the number of episodes per week is no longer a central criteria for a diagnosis. In the DSM IV, the binge/purge cycle had to be present 3-4 times per week. Under the new criteria, the number of episodes per week has been reduced to one. Again, this change will result in more people with BN being able to access effective care.

Next week: The comorbidity between borderline personality disorder and eating disorders  

Contributions by Sarah Emerman