Psychiatrists and other mental health professionals rely upon the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association (APA) in their diagnosis and treatment of eating disorders. On December 1, 2012, the APA's Board of Trustees approved the publication of the fifth edition of the manual (DSM‑5), which will be released in May 2013.
The new DSM-5 makes long overdue and important changes to the criteria used in the diagnosis of eating disorders. These include:
Binge Eating Disorder – The DSM-5 adds Binge Eating Disorder (BED) as a separate diagnosis when it had previously been classified under the more general diagnosis of Eating Disorder Not Otherwise Specified (EDNOS). BED is defined as having "a sense of lack of control over eating."
BED may be the most common eating disorder affecting as many as three percent of the U.S. population, or roughly 10 million Americans, three times more than those diagnosed with Anorexia and Bulimia combined. BED also has significant medical complications. Thus, those suffering with BED will benefit by having a separate diagnostic category, since they will receive the proper diagnosis and treatment for their symptomatology.
Bulimia Nervosa – The main change in the diagnosis of Bulimia Nervosa is that the number of times a person binges and purges per week is no longer a central criterion for a diagnosis of Bulimia. In the DSM-5, the binge/purge cycle criterion is now at least once per week for three months. Previously, if binging and purging occurred less than twice per week for three months, the individual would be diagnosed with EDNOS.
Anorexia Nervosa – The main change in the diagnosis of Anorexia Nervosa was to remove the criterion of amenorrhea (loss of menstrual cycle). Removing this criterion means that boys and men with Anorexia will finally be able to receive an appropriate diagnosis. In the past, men and boys with Anorexia were either diagnosed with EDNOS or Bulimia, Restricting Subtype. Similarly, girls and women who continue to have their period despite other symptoms associated with Anorexia, such as weight loss and food restriction, will now be eligible for a diagnosis of Anorexia. In addition, the first criterion for Anorexia, which is currently that the "patient must be 85% or less than their recommended body weight," is removed. The DSM-5 now addresses weight by requiring "restriction of energy intake . . . leading to significantly low body weight."
By updating the diagnostic criteria, the changes in DSM-5 should help those suffering from eating disorders receive proper treatment, and, hopefully, also help them obtain insurance coverage. For example, many insurance companies have long relied upon the DSM-IV criterion that "the patient must be 85% or less than their recommended body weight" as a way to restrict or terminate treatment for Anorexia for anyone above that percentage or who reached that percentage while in treatment. Without this criterion, insurance companies can no longer rely upon a percentage of body weight as a barrier to treatment.
While the DSM-5 is not perfect, and while some insurance companies will continue to try to deny or limit treatment for eating disorders, we believe that the changes made to the eating disorders diagnoses in the DSM-5 are a positive step forward and that the changes will aid clinicians in making more accurate diagnoses and allow those suffering from eating disorders to receive proper treatment.