The draft criteria for eating disorders in the upcoming (and much discussed) revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM) have been published this morning. The two most important changes are the listing of Binge Eating Disorder as a stand-alone diagnosis and the removal of the amenorrhea criteria for anorexia nervosa. There were othermore subtle changes that I will discuss in their own blog post a little later.
You can click here for the eating disorders section of the DSM draft criteria.
Here are the diagnosis as listed in the draft version Anorexia Nervosa
A. Restriction of food intake relative to caloric requirements leading to the maintenance of a body weight less than a minimally normal weight for age and height (e.g.weight loss leading to maintenance of body weight less than 85% of that expected; or failure to make expected weight gain during period of growthleading to body weight less than 85% of that expected).
B. Intense fear of gaining weight or becoming fateven though underweightor persistent behavior to avoid weight gaineven though underweight.
C. Disturbance in the way in which one's body weight or shape is experiencedundue influence of body weight or shape on self-evaluationor persistent lack of recognition of the seriousness of the current low body weight.
Specify current type Restricting Type: during the last three monthsthe person has not engaged in recurrent episodes of binge eating or purging behavior (i.e.self-induced vomiting or the misuse of laxativesdiureticsor enemas)
Binge-Eating/Purging Type: during the last three monthsthe person has engaged in recurrent episodes of binge eating or purging behavior (i.e.self-induced vomiting or the misuse of laxativesdiureticsor enemas)
A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following (1) Eatingin a discrete period of time (e.g.within any 2-hour period)an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances
(2) A sense of lack of control over eating during the episode (e.g.a feeling that one cannot stop eating or control what or how much one is eating). B. Recurrent inappropriate compensatory behavior in order to prevent weight gainsuch as self-induced vomiting; misuse of laxativesor diuretics.
C. The binge eating and inappropriate compensatory behaviors both occuron averageat least once a week for 3 months.
D. Self-evaluation is unduly influenced by body shape and weight.
E. The disturbance does not occur exclusively during episodes of anorexia nervosa.
Eating Disorder Not Otherwise Specified
(These aren't actual diagnostic criteriajust a discussion of the issues around EDNOS and how it might change based on other changes in ED diagnostic criteria.)
It is recommended that Binge Eating Disorderdescribed in this section of DSM-IVbe recognized as an independent disorder in DSM-5. Recommended changes in the criteria for Anorexia NervosaBulimia Nervosaand for eating and feeding disorders usually beginning in childhood should also reduce the need for Eating Disorder Not Otherwise Specified.
The work group is considering whether it may be useful and appropriate to describe other eating problems (such as purging disorder--recurrent purging in the absence of binge eatingand night eating syndrome) as conditions that may be the focus of clinical attention. Measures of severity would be requiredand these conditions might be listed in an Appendix of DSM-5.
If these recommendations are acceptedthe examples in Eating Disorder Not Otherwise Specified will be changed accordingly.
Binge Eating Disorder
A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following 1. eatingin a discrete period of time (e.g.within any 2-hour period)an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances
2. a sense of lack of control over eating during the episode (e.g.a feeling that one cannot stop eating or control what or how much one is eating)B. The binge-eating episodes are associated with three (or more) of the following 1. eating much more rapidly than normal
2. eating until feeling uncomfortably full
3. eating large amounts of food when not feeling physically hungry
4. eating alone because of being embarrassed by how much one is eating
5. feeling disgusted with oneselfdepressedor very guilty after overeatingC. Marked distress regarding binge eating is present.
D. The binge eating occurson averageat least once a week for three months.
E. The binge eating is not associated with the recurrent use of inappropriate compensatory behavior (i.e.purging) and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa