Running head: EATING DISORDERS
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Recent Changes in the Diagnoses of Eating Disorders
Erin Buell
Concordia University
Lifespan Development
HS 555
Cheryl Durheim
January 25, 2014
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Recent Changes in the Diagnoses of Eating Disorders
Anorexia nervosa (AN) and bulimia nervosa (BN) were recognized in the Diagnostic and
Statistical Manual (DSM) IV. The chapter of DSM IV titled Disorders Usually First Diagnosed
in Infancy, Childhood or Adolescence, was the location of these diagnostic entities (American
Psychiatric Publishing, 2013). However, the DSM V, released in May 2013, does not include
this chapter. Instead, this new manual recognizes eating disorders as a category of diagnoses that
is identified throughout the lifespan. Furthermore, other eating disorder conditions besides AN
and BN, such as pica (compulsive cravings to eat non –food items), rumination and avoidance or
restrictive food intake disorder, and binge eating disorder are included in the DSM V that were
not identified in previous versions (American Psychiatric Publishing, 2013). Eating disorders not
otherwise specified, or EDNOS, has been a category of default for many eating disorders, and is
now getting attention in order to determine if a significant number of these cases are actually
binge eating disorders (American Psychiatric Association, 2013).
Prevention, intervention, and treatment are key concepts in literature addressing these
disorders. Inclusion of a broader scope within the DSM-V draws specific diagnostic definition
for medical and psychology professionals and may enable clinical professionals to make better
diagnoses and prescribe treatment in conventional and professionally recognized medical
methods.
Anorexia nervosa is characterized by body weight 15% below specified ideal healthy
weight, distorted body image, dieting that leads to extreme weight loss, and pathological fear of
gaining weight or being fat (Beerbower & Contner, n.d). In the DSM IV, amenorrhea was
included as a criterion for the diagnosis of AN (American Psychiatric Publishing, 2013). In the
current manual, amenorrhea is being eliminated. Amenorrhea can only be a possible factor in
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women and adolescent girls, which excludes the possibility of this diagnosis for males, young
girls, post-menopause women, pregnant females, or women who do not menstruate for other
reasons (American Psychiatric Association, 2013).
Anorexia nervosa has the highest mortality rate of eating disorders. Research points to
predictors of increased mortality linked to chronicity and severity of illness. Research is
primarily based on information obtained upon physician visits and hospitalization of the affected
individual (Haus, et al., 2010). Girls aged 15 – 19 are recognized as the highest risk group for
anorexia nervosa, yet it occurs throughout the life span and crosses gender parameters. Binge
eating disorders are reported to be the most common eating disorders among men and older
individuals, and can be associated with unhealthy weight gain (Smink, VanHoeken, & Hoek,
2012).
Traditional diagnoses and treatment include psychiatric and psychological care, nutrition
counseling, and hospitalization. In addition, some current research and literature is addressing
whether internet-based programs have merit in improving outcomes for individuals affected with
eating disorders. Evidence has been collected regarding the efficacy of internet based
interventions for conditions such as depression, anxiety, and the prevention of eating disorders.
While internet based interventions exist for eating disorders, the quest for determining outcome
of such programs is under current investigation (Dolemeyer, Tietjen, Kersting, & Wagner, 2013).
Advantages of internet based programs appear to include that they provide easy access,
especially for the adult population, allow user control and flexibility, and support anonymity.
Risks involve the absence of direct clinical care.
Evidence shows that anorexia and other eating disorders have existed throughout history
(Dean, 2011), but the primary focus has been on anorexia and bulimia in adolescent girls and
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young women (American Psychiatric Publishing, 2013). Attention is growing on other
demographics such as men and boys, children, and middle aged individuals. Collecting exact
data is difficult as many individuals with eating disorders do not seek clinical help and are not
included in statistics. However, according to the National Eating Disorder Association, an
estimated 20 million women and 10 million men are reported to have eating disorders, (NEDA,
n.d.).
New vocabulary of terms for non-clinically recognized forms of eating disorders has
surfaced in recent years, including orthorexia (obsession with eating healthy food to the extent of
severe food restriction.), pregorexia (eating disorder during pregnancy), drunkorexia (food
restrictions in favor of alcohol consumption), and diabulimia (individuals with diabetes
eliminating or reducing insulin specifically for the purpose of being thin) (Beerbower & Contner,
n.d). These terms are not readily found in peer reviewed literature, but are currently more
frequently discussed in popular journals.
As the DSM V integrates into the clinical professions, research and metrics will be
delineated based on new clinical criteria for the prevention, recognition, intervention, diagnoses,
and treatment of eating disorders. The catch-all diagnoses of eating disorder not otherwise
specified (ENOS), other specified feeding and eating disorder (OSFED), and unspecified feeding
and eating disorder (UFED) do not support clinicians efforts to identify a specific diagnoses
based on symptoms and behaviors (American Psychiatric Association, 2013). The modifications
within the DSM V will help both patients and medical professionals create and implement
treatment plans through more accurate diagnoses (American Psychiatric Association, 2013).
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References
American Psychiatric Publishing.(2013). Highlights of changes from DSM-IV-TR to DSM-5.
Retrieved from http://www.dsm5.org/Documents/changes%20from%20dsm-ivtr%20to%20dsm-5.pdf
American Psychiatric Association. (2013). Feeding and Eating Disorders. Retrieved from
http://www.dsm5.org/Documents/Eating%20Disorders%20Fact%20Sheet.pdf
Beerbower, K., & Contner, E. (n.d). Emerging trends in the field of eating disorders. . Retrieved
from http://www.cigna.com/assets/docs/behavioral-health-series/eastingdisorder/2012/emergingTrends.pdf
Dean, E. (2011, December 11). A history of eating disorders. Psychology Today. Retrieved from
https://www.psychologytoday.com/blog/evolutionary-psychiatry/201112/history-eatingdisorders
Dolemeyer, R., Tietjen, A., Kersting, A., & Wagner, B. (2013). Internet-based interventions for
eating disorders in adults: a system review. BMD Psychiatry, (), 1-16. Retrieved from
http://web.ebscohost.com.vproxy.cune.edu/ehost/pdfviewer/pdfviewer?vid=4&sid=97389
488-002c-4a9b-996c-803f6b162478%40sessionmgr4002&hid=4207
Haus, C., Caille, A., Godart, N., Faulon, C., Pham-Scottez, A., Divac, S., ... Falissard, B. (2010).
Factors predictive of ten-year mortality in severe anorexia nervosa patients. Acta
Psychiatrica Scandinavica, 123(1), 62-70. http://dx.doi.org/ 10.1111/j.16000447.2010.01627.x
NEDA. (n.d.). Get the facts on eating disorders; what are eating disorders? Retrieved from
http://www.nationaleatingdisorders.org/get-facts-eating-disorders
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Smink, F. R., VanHoeken, D., & Hoek, H. W. (2012, May 27). Epidemiology of eating
disorders; incidence, prevalence and mortality rates. Current Psychiatry Reports, 14, 406414. http://dx.doi.org/10.1007/s11920-012-0282-y