The Importance of the DSM-5 in the Diagnosis of Eating Disorders

Contributor: Amy M. Klimek, MA. LPC, Eating Disorder Program Coordinator, Timberline Knolls Residential Treatment Center

Medical problems of a physical nature are often easier to diagnose than those of a psychiatric nature. This is due, by and large, to the fact that the relevant criteria for assessment and diagnosis are not tangible. They do not show up on an x-ray or in a blood test thus making the diagnosis of eating disorders more difficult.

Much of it would be sheer guesswork if not for the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association.

Since first issued in 1952, the manual has provided a listing of diagnostic criteria for every psychiatric disorder recognized by the U.S. healthcare system. It is periodically updated to reflect the changing times. The DSM-5 was published in 2013, replacing the DSM-IV, which had been the go-to resource for nearly two decades.

The changes for eating disorders in the DSM-5 help to minimize a broad generalization of eating disorders. Toward that end, this publication provides a more accurate description of symptoms and behaviors for those suffering from eating and feeding disorders.

Anorexia Nervosa, Bulimia Nervosa and Binge Eating Disorder

Historically, a defining characteristic of anorexia was amenorrhea, which is the discontinuation of the menstrual cycle. This is no longer the case for two reasons. First, it automatically excluded men from being associated with the diagnosis; and second, it negated the impact of the birth control pill. Even if a female met all criteria for anorexia, if she was taking the pill, her body could still produce a monthly period.

The language was also changed regarding the definition of low weight, which now substantially decreases the emphasis on the body mass index (BMI).

The criteria for bulimia experienced a significant change regarding the frequency of episodes of inappropriate compensatory behavior. In the DSMIV, the guideline was using a compensatory behavior on average at least twice a week for three months. That has been changed to once a week.

The range of severity within the diagnosis can assist in the description of an individual’s presentation. If a woman is purging once a week, this is considered low; if another is purging 15 times a week, her illness is considered severe.

One of the most significant changes pertains to binge eating disorder (BED). In the past this disorder was not fully legitimized, for it was classified under the umbrella of Eating Disorder Not Otherwise Specified.

In the DSM-5 it has achieved the same status as anorexia and bulimia. This is critical since BED is the fastest growing eating disorder in the United States today. Similar to bulimia, the frequency has been changed from two times a week to one.

For all of these disorders, severity levels have been added. Designations of mild, moderate and severe, have been laid out, so once the diagnosis is made, it is possible to indicate how severe the disorder is.

Otherwise Specified Feeding and Eating Disorders

In the previous manual, the designation Eating Disorder Not Otherwise Specified (EDNOS) served as a catch-all category, meaning if an individual’s presentation did not fit into the main categories of anorexia or bulimia, their behaviors could be recognized under this category.

This has now been replaced by Otherwise Specified Feeding and Eating Disorders (OSFED), which provides a higher level of specificity for those in the field.

Other diagnosis of eating disorders include:

Pica
This disorder is concerned with the ingesting of non-nutritive food. Essentially this is when an individual routinely consumes items that are not food such as paper, chalk or dirt. Often this is conducted as a method of preventing or controlling appetite.

Rumination Disorder
In this, an individual suffers from repeated regurgitation and rechewing of food, then either spitting it out or more frequently, reswallowing the food.

Purging Disorder
Different from bulimia, purging disorder does not present with binging behavior. With this disorder, an individual consumes food in a normal fashion, but then purges the food in order to control weight or body shape.

Night Eating Syndrome
This is recognized when an individual eats excessively in the evening hours or upon waking during the night. The individual has awareness and recalls the events.

Because of the DSM-5, clinicians are now better able to make accurate diagnosis for those struggling with eating disorders. Improved diagnostics naturally translates into more thorough and complete treatment with a greater chance of complete and lasting recovery.

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About the Author:

As the Eating Disorder Program Coordinator, Amy facilitates supervision for Eating Disorder Specialists, offers support through training to TK staff, and provides education on eating disorders to the community.

Amy started at Timberline Knolls as a Behavioral Health Specialist. As such, she provided support at the milieu level for all residents. She transitioned to Eating Disorder Specialist in 2012, supporting healing in present moment experiences for residents who struggled with eating disorders and body image. Amy earned a Bachelor of Science Degree in Sociology from the University of Illinois. She was awarded a Master’s Degree in Counseling specializing in both community and school counseling from Lewis University.

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The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Last Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on February 24, 2016
Published on EatingDisorderHope.com