Anticipated DSM-V Changes Will Enhance Eating Disorders Diagnosis

In the much-anticipated revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM), binge eating disorder (BED) is on track to becoming a formal psychiatric diagnosis, according to Dr. Tim Walsh of Columbia University, emeritus EDR Editorial Board member. Dr. Walsh outlined several anticipated changes in the overall eating disorders category in the DSM-V at the American Psychiatric Association meeting in New Orleans at the end of May. According to Dr. Walsh, currently there does not appear to be enough hard evidence to support creating a psychiatric diagnosis for obesity or overeating. However, he noted that there might be evidence for establishing an overeating syndrome that is distinct from BED.

Dr. Walsh also told the meeting participants that the major eating disorders category, including anorexia nervosa (AN), bulimia nervosa (BN), and eating disorders not otherwise specified (EDNOS), had long cried out for an overhaul. While initially three additional categories/diagnoses were proposed to better differentiate types of patients with EDNOS (which includes some 45% of patients treated for eating disorders), the DSM-V work group decided that such changes would be premature. Instead, the additional categories may be included in an appendix to the DSM-V. Dr. Walsh also noted that some changes are expected in the diagnostic criteria for AN and BN. For AN, the first criterion, which is currently “85% of recommended body weight,” now will be reworded as, “restriction of energy intake [leading to] markedly low weight.” In addition, the much-debated criterion of amenorrhea has been dropped from the list of symptoms associated with AN.

As for BN, diagnosis will be easier than before because of a change in the required frequency of binge-purge episodes, according to Dr. Walsh. Whereas the current DSM criterion for BN specifies that episodes of binge-eating and purging must occur twice a week for the previous 3 months for a diagnosis of BN to be made, the new criterion allows the diagnosis to be made when the binge/purge frequency is once a week.