The book Developing an Evidence-Based Classification of Eating Disorders: Scientific Findings for DSM–5 provides an overview of the controversies surrounding the classification of eating disorders. Among the topics discussed are the advantages of changing the Diagnostic and Statistical Manual (DSM) from a categorical to a dimensional framework and the value of reducing the use of the classification Eating Disorder, Not Otherwise Specified (ED-NOS). In her review of the book, Marla Sanzone highlights the focus on a dimensional versus a categorical framework for classification. She notes from the book that the dimensional framework is meant to
increase the consistency and meaning of differences among symptoms and minimize the confusion common to descriptive methods that frequently introduce subtypes within each category and overlapping qualities between diagnostic categories. Examples in current DSM-IV eating disorder classifications would include anorexia, restricting type; anorexia, binge-eating/purging type; bulimia, purging type; and bulimia, nonpurging type (American Psychiatric Association, 1994).
However, some researchers and clinicians might ask if this change is sufficient to achieve the goals of a diagnostic manual. Wilfley et al. (2007) state,
There are numerous examples in medicine where the line between disease (such as diabetes or hypertension) and normality is blurred, and cutpoints are defined based on prognostic indicators, thus simultaneously employing a dimensional and categorical model. (p. S124)
Sanzone points to the suggestions of Becker et al. in Chapter 20. These authors propose
that considering anxiety and mood disorders as the primary diagnosis and eating disorders as a secondary diagnosis could allow for integration of idiosyncratic presentations such as anxiety with and without food- or weight-phobic behavior. This could significantly reduce the frequency of eating disturbances garnering the ED NOS diagnosis.
While it is true that the use of ED NOS might decrease, such a change complicates the diagnostic framework for mood disorders.
Despite the discussion, the most significant change in the DSM-5 is the proposal of binge eating as a stand-alone diagnostic category and removal of the amenorrhea criteria from the anorexia diagnosis. What of the other diagnostic criteria provided? Given the variety of suggestions offered to address concerns related to the classification of eating disorders, researchers and clinicians alike may be left wondering whether DSM-5 will resolve the major issues of concern. Are there preferences in approach among psychologists providing treatment? To what extent will any of the proposed changes in the DSM-5 eating disorders classification affect treatment planning and intervention?
Wilfley, D., Bishop, M., Wilson, G., & Agras, W. (2007). Classification of eating disorders: Toward DSM-V. International Journal of Eating Disorders, 40, S123-S129.
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