DSM V Changes to Eating Disorder Diagnoses

For the past year Kartini Clinic staff have been actively involved in helping to revise diagnostic definitions of eating disorders in children for the upcoming Diagnostic and Statistical Manual (DSM), 5th Edition. The latest recommendations of the working group on eating disorders have been issued in a report to the American Psychiatric Association. Here are some of the highlights:

Obesity Ruled Out as Psychiatric Condition

Neither obesity nor simple overeating will be included in the DSM-5, the forthcoming revision to the Diagnostic and Statistical Manual of Mental Diseases, reports medpagetoday.com.

In a report to the American Psychiatric Association's annual meeting B. Timothy Walsh, MD, of Columbia University in New York City, head of the DSM-5 work group noted that he and his colleagues did not believe there was enough hard evidence to support creating a psychiatric diagnosis for obesity or overeating.

Darrel Regier, MD, MPH, the APA's research director, commented that a number of studies have suggested that people who eat excessively have biological similarities, in terms of neural firing patterns, to those with substance addictions.

EDNOS Eating Disorder Diagnosis to Change

In a report to the American Psychiatric Association's annual meeting B. Timothy Walsh, MD, of Columbia University in New York City, head of the DSM-5 work group told attendees that eating disorder diagnostic categories had cried out for an overhaul. The current edition of the DSM lists just three types for adults: anorexia, bulimia, and eating disorders not otherwise specified (EDNOS).

Studies reviewed by the work group suggested that up to 45% of all patients treated for eating disorders receive a diagnosis of EDNOS, an indication that the current classifications are inadequate.

Anorexia and Bulimia Definitions to be Refined

Also in the offing are some changes to the diagnostic criteria for anorexia and bulimia.

The current definition had been criticized in part because it included an example of "85% of recommended body weight" as an indicator that a person was too thin. Walsh said the work group agreed that this figure, though not a hard and fast criterion for diagnosis, was arbitrarily restrictive.

In the revision, the first criterion has been reworded to say "restriction of energy intake [leading to] markedly low weight."

Other criteria have undergone minor wording changes as well, and amenorrhea has been dropped entirely from the list of symptoms that may be associated with anorexia. For bulimia, a diagnosis will be easier than before because of a change in the required frequency of binge-purge episodes.

Whereas the current DSM specifies that episodes must occur twice a week for the previous three months, the new criteria allow a diagnosis when the frequency is once a week. The new binge eating category and the anorexia and bulimia revisions should greatly cut down on EDNOS diagnoses, Walsh said.

Analysis of 247 calls to an eating disorder clinic indicated that only 15% would receive an EDNOS diagnosis under the new criteria, compared with 39% using the existing system, he said.