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DSM-5 Changes in the Diagnosing of Eating Disorders


The latest revision of the psychiatric diagnostic manual, the DSM-5, is now being used by clinicians. In it are a few changes to the way eating disorders will be assessed and diagnosed.

The most significant change to the eating disorder category is the official recognition of binge eating disorder as a stand-alone diagnosis. There are also a couple symptom revisions in the anorexia and bulimia nervosa categories, and the inclusion of three diagnoses formerly listed elsewhere in the DSM-IV.

DSM-5 Changes in Anorexia Nervosa

Anorexia nervosa is characterized by symptoms of extreme dieting with drastic weight loss, an intense fear of getting fat, and having a distorted body image. In the DSM-5, two changes were made to the diagnostic criteria for this disorder.

  1. The DSM-IV criteria A stated, “Refusal to maintain body weight at or above a minimally normal weight for age and height.” The DSM-5 kept criteria A but eliminated the word “refusal.” Why? Assessing an individual’s intention regarding the symptoms of anorexia is difficult, if not impossible.
  2. The DSM-IV criteria D indicated, “...the absence of at least three consecutive menstrual cycles.” This criterion was eliminated in the DSM-5. Why? This criterion cannot be applied to many people with symptoms of anorexia such as young females, males, women taking oral contraceptives, and post-menopausal women. Plus, some women with all other signs of anorexia continue to menstruate.

DSM-5 Changes in Bulimia Nervosa

Bulimia nervosa is characterized by symptoms of binge eating followed by actions taken to avoid weight-gain such as self-induced vomiting.

The DSM-IV criteria included, “The binge eating and inappropriate compensatory behavior both occur, on average, at least twice a week for 3 months.” The DSM-5 reduces the frequency of binging and compensatory behaviors to at least once per week for 3 months.

DSM-5 Addition of Binge Eating Disorder

The DSM-IV did not recognize the problem of binge eating as a separate disorder. Individuals with symptoms of binge eating were given a seemingly generic diagnosis of “eating disorder not otherwise specified.” However, decades of research results have defined binge eating with a distinct profile of symptoms now to be recognized by clinicians.

Binge eating criteria includes overeating at least once per week for 3 months, accompanied by a lack of control and emotional distress. Other criteria are:

  • eating quickly, faster than normal
  • eating past the point of fulness; being uncomfortably full
  • eating large portions though not actually hungry
  • eating in isolation to avoid embarrassment

DSM-5 Other Eating Disorder Changes

In the DSM-IV, the disorders of pica (eating non-nutritive substances), rumination (effortless regurgitation of food), and avoidant/restrictive food intake were listed in a chapter called Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence. Because this chapter is not in the latest revision, these three disorders are now in the DSM-5’s section on eating disorders.

source: Psychiatric News