DSM-5: Key Changes in the Diagnosing of Eating Disorders

The American Psychiatric Association published the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) on December 1, 2012. Since being released in May 2013, the updated DSM-5 has modernized the criteria and classification framework for diagnosing eating disorders. In this article, we’ll take a look at the three main DSM-5 changes you need to be aware of.

Changes to Binge Eating Disorder Criteria

Binge eating disorder is a compulsive psychological illness that causes a loss of control during eating. In the DSM-5, binge eating disorder is classified as a standalone diagnosis. However, prior to the changes listed in DSM-5, binge eating disorder came under the general umbrella diagnosis of Eating Disorder Not Otherwise Specified (EDNOS).

The updated diagnosis criteria for binge eating disorder is especially important given how widespread binge eating disorder is across the U.S. According to some estimates, 10 million Americans, or just under three percent of the entire U.S. population, are affected by binge eating disorder every year.

By establishing a distinct diagnostic criterion for binge eating disorder, medical professionals will have access to a relevant symptomatology framework, streamlining both the diagnosis and treatment process.

Changes to Bulimia Nervosa Criteria

The most important change in DSM-5 bulimia nervosa criteria relates to the binge/purge cycle diagnosis framework. Previously, the DSM-4 stipulated that a person who binged or purged less than two times per week could only be diagnosed with an EDNOS condition. Since the release of DSM-5, a diagnosis of bulimia nervosa is now applicable if a person exhibits binging and purging behavior at least once per week.

Changes to Anorexia Nervosa Criteria

DSM-5 updates several different anorexia nervosa diagnosis requirements. The first important change in DSM-5 is the removal of the amenorrhea criterion. Amenorrhea is a medical classification for the loss of three consecutive menstrual cycles. Prior to DSM-5, the amenorrhea condition made it technically impossible for physicians to diagnose men and young boys with anorexia nervosa. Instead, doctors had to incorrectly diagnose anorexia nervosa in males as an EDNOS condition. Removing the amenorrhea condition also allows doctors to apply an anorexia nervosa diagnosis for women who continue to menstruate despite showing other symptoms of anorexia.

The second important change in anorexia nervosa criteria is the removal of specific weight loss requirements. Before DSM-5, people diagnosed with anorexia nervosa had to weigh 85 percent or less than their recommended body weight. DSM-5 has since changed the weight condition to the more flexible standard: "restriction of energy intake…leading to significantly low body weight."

Sources: Eating Disorder Hope, Opal Food & Body, Eating Disorders Victoria
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