For those working in the field of behavioral health, the “go-to” book for definitions of the various mental illnesses is The Diagnostic and Statistical Manual of Mental Disorders (DSM). The current version, DSM-IV, was released in 1994 and the updated manual is slated for release in May 2013. Several changes will affect the eating disorder community. The term NOS or not otherwise specified will be eliminated from the DSM-5; therefore, the diagnosis of ED-NOS will no longer be utilized. Binge Eating Disorder (BED) will be elevated to a distinct category of eating disorder, replacing NOS. In the previous manual BED appeared in the appendix, sending a message to the behavioral health community indicating the need for more research in this particular area. That message was received and in the 20 years since publication of DSM-IV, there have been more than 1,000 papers published on BED, which provided a strong basis for the argument that it was appropriate for inclusion in the updated manual. For a diagnosis of Binge Eating Disorder, the food and eating-related behavior occurs on average at least once a week for three months and is not associated with the recurrent use of inappropriate compensatory behavior (such as the purging that happens with bulimia). The behavior is marked by “a sense of lack of control over eating during the episode” and is associated with three or more of the following:
- Eating much more rapidly than normal
- Eating until feeling uncomfortably full
- Eating large amounts of food when not feeling physically hungry
- Eating alone because of feeling embarrassed by how much one is eating, and/or feeling disgusted with oneself, depressed, or very guilty afterward.
As mental health professionals eagerly await the publication, those in the eating disorder specialization are among them. The National Eating Disorders Association (NEDA) is most excited about the change in the DSM-5, moving Binge Eating Disorder (BED) from something previously mentioned in Appendix B as a topic for further discussion, to a recognized illness. This change can prove to be significant for many reasons. This DSM-5 alteration has two distinct benefits for those suffering with BED. First, this status change, in effect, provides greater legitimacy to the disorder. It will hopefully result in greater awareness and improved diagnosis. Second, those with BED will have the opportunity to receive the treatment they need with the benefit of insurance coverage. Currently, insurance is only extended if specific criteria are met, which definitely creates a roadblock to treatment for many men and women. The DSM is widely used by insurance companies to determine care for an individual, and establishing BED as a real illness that can be treated – not as a decision of poor eating habits – as is often mistakenly assumed, is critical to appropriate treatment and insurance coverage. Medical professionals have the potential to become more sensitive to the needs of those who may be suffering from BED, and the importance of providing treatment referrals to eating disorder specialists. The National Institutes of Health requires diagnosis to be in the DSM for research grants – something that could positively affect research for the area of eating disorders. Nutritionists and dieticians may also address obesity concerns in their clients– a common side effect of BED – differently if they can recognize symptoms and direct clients to Binge Eating Disorder treatment, rather than weight management programs. Information sources: Eating Disorder Hope, National Eating Disorders If you are interested in following along with BED Week, you can join the event on facebook or follow it on twitter by using the hashtags #BEDWEEK, #DSM5, #BEDAWARENESS, #EATINGDISORDER and #ED. We will also be taking questions (option to remain anonymous) at the email address BEDWEEKQUESTIONS@gmail.com for our live tweetchat on May 29th at 12-1:00 pm!