Diagnostic Changes for Eating Disorders in the DSM-V

How have the criteria for diagnosing eating disorders changed?

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The diagnostic criteria for eating disorders underwent major changes with the release of the Diagnostic & Statistical Manual of Mental Disorders fifth edition, in several cases making it easier for clinicians to diagnose someone with an eating disorder.

The DSM often is referred to as the "bible" of the psychiatric and mental health world, and so diagnostic changes in new editions carry significant weight with mental health professionals.

The current edition, the DSM-V, was published in 2013 and had been both long-awaited and hotly debated among researchers and clinicians. The previous edition, the DSM-IV-TR, was published in 2000.

Here's a brief synopsis of the changes for diagnosing eating disorders contained in the DSM-V:

Binge-Eating Disorder

For the first time, the DSM-V includes binge-eating disorder as a fully recognized and diagnosable disorder.

The DSM-IV-TR had included binge-eating disorder as a provisional list of criteria “for research purposes.” Essentially, the edition viewed binge-eating disorder as being so newly recognized that the criteria for the disorder hadn’t been completely thought through and ironed out.

Ideally, this change should provide more validity to those who are struggling with binge eating, and will hopefully provide them with more coverage and treatment options, as well.

Anorexia Nervosa

The DSM-V made two major changes to the way anorexia nervosa is diagnosed, both of which should make it easier to be diagnosed with the condition.

In the DSM-IV-TR, in order for a person to qualify for a diagnosis of anorexia nervosa, their weight had to be at or under 85% of their ideal body weight (according to the body mass index), thus excluding those who were clearly suffering but hadn’t yet lost enough weight to be officially diagnosed.

The DSM-V has reworked that to say that the person as reached a “significantly low weight.” It also provides treatment professionals with the ability to specify the severity of the disorder in relation to body mass index.

The second major change to the diagnosis of anorexia nervosa is that teen girls and women no longer have to have lost their periods (a condition technically called amenorrhea) in order to be diagnosed with the anorexia nervosa. In the prior edition of the DSM, women had to have skipped three or more periods to be diagnosed.

Bulimia Nervosa

The DSM-V criteria for bulimia nervosa requires binge eating and compensatory behaviors to occur for at least once a week for at least three months. That's a change from the previous criteria in the DSM-IV-TR, which required binge eating and compensatory behaviors to occur at least twice a week for at least three months.

The former edition also listed separate categories for the purging type of bulimia nervosa (when you self-induce vomiting or use laxatives) and the non-purging type of bulimia nervosa (when you use fasting or excessive exercise). Within the new edition, all of these types of behaviors are lumped together, since clinicians now recognize that sufferers can engage in a variety of behaviors.

The new edition also allows professionals to specify whether the person is in partial or full remission (recovery) from the disorder, and how severe their disorder is. The levels of severity are based on how frequently the person experiences binge and purging episodes as well as how much the disorder affects day-to-day life.

Other Types of Feeding or Eating Disorders

The DSM-V included two other forms of eating disorder: "other specified feeding or eating disorder" and "unspecified feeding or eating disorder." These had been lumped together as "eating disorder — not otherwise specified" in the DSM-IV-TR.

"Other specified feeding or eating disorder" is more specific and applies primarily to people who are presenting with some or most of the symptoms of anorexia nervosa, bulimia nervosa or binge-eating disorder but either haven’t lost enough weight, aren’t experiencing symptoms often enough or haven’t been suffering for long enough to qualify for a full diagnosis. It also includes purging disorder which occurs when someone uses purging behaviors but does not engage in binge-eating behaviors (as in bulimia nervosa).

"Unspecified feeding or eating disorder" is for problems that don’t fit into any current category or when the diagnosing professional doesn’t have enough information (such as in an emergency room).

Diagnostic Criteria: A Work in Progress

It is important to note that the DSM is always, and always has been, a work in progress. There continue to be debates and disagreements among professionals about even the most current diagnostic criteria.

However, the definitions included in the DSM do provide researchers and clinicians with a language for talking about and describing sets of symptoms with which many people are struggling, and for which they need treatment.

If you, or someone you know, is suffering from some or all of the symptoms of any eating disorder, please consult with a physician, dietitian or mental health professional for assessment and treatment.

Sources:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., Text Revision). Washington, DC: Author.

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