The latest revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), to be published by the American Psychiatric Association in May 2013, will expand the definition of anorexia and bulimia so that fewer patients will receive the diagnosis of Eating Disorder Not Otherwise Specified (EDNOS). The most significant reduction in EDNOS will be the official recognition of Binge-Eating Disorder (BED) as a distinct eating disorder. Another important change is that amenorrhea (loss of menstrual cycles) will no longer be required for the diagnosis of anorexia. This means that boys and men with anorexia will finally receive an appropriate diagnosis rather than being lumped into EDNOS. Girls and women who continue to have periods despite severe weight loss and food restriction will also rightfully be diagnosed with anorexia. Also to be included in anorexia will be the previously exclude groups of females having periods because they are on estrogen or couldn't be amenorrheic because they were too young or old to have naturally occurring periods. Bulimia will be expanded to include people who binge and purge at least 1x per week for 3 months. Previously if bingeing and purging occurred less than 2x week for 3 months, the patient would be diagnosed with EDNOS. The new definition of EDNOS remains essentially unchanged in DSM-V. It will read: "EDNOS "is for disorders of eating that do not meet the criteria for any specific Eating Disorder."
Researchers have pushed for the DSM-V changes because the catch-all EDNOS diagnosis made it impossible to do effective research. As far as for practitioners like me, these changes won't change my treatment approaches. But if the new DSM-V, with its expanded diagnoses of anorexia and bulimia and the brand-new BED encourages health professionals, families, and sufferers to take action sooner, then these revisions are an exciting development.
While no one seems to know for sure how DSM-V with affect insurance coverage for eating disorders, I worry that more and more insurance plans will not cover treatment for the what is left in EDNOS. If EDNOS is not covered, many patients would not or could not seek treatment until their behaviors have become more dangerous and entrenched enough to qualify for either anorexia or bulimia. Let's not forget that EDNOS remains the most important diagnosis for early intervention and treatment.
Nutritionist Marcia Herrin and Nancy Matsumoto, co-authors of The Parent's Guide to Eating Disorders, Gūrze Books, (www.childhoodeatingdisorders.com). Marcia is also author of Nutrition Counseling in the Treatment of Eating Disorders (www.marciaherrin.com).
Copyrighted by Marcia Herrin and Nancy Matsumoto