Important Changes in Eating Disorder Diagnoses in DSM-V

The newest edition of the Diagnostic and Statistical Manual of Mental Disorders includes some important changes in the diagnosis of various eating disorders. These changes will allow for more accurate diagnoses and better treatment plans for individuals affected by eating disorders.

Binge Eating Disorder
Binge eating disorder will now have its own category as an eating disorder. In the DSM-IV, binge-eating disorder was not recognized as its own disorder but rather was diagnosable under the category Eating Disorder Not Otherwise Specified (EDNOS). Binge eating disorder is defined as “recurring episodes of eating significantly more food in a short period of time than most people would eat under similar circumstances, with episodes accompanied by feelings of lack of control.”  Someone with BED may eat quickly and uncontrollably, despite hunger signals or feelings of fullness. The person may have feelings of guilt, shame, or disgust and may binge eat alone (sometimes at night) to hide the behavior. To be diagnosed with BED, the behavior will have typically taken place at least once a week over a period of three months.
This revision is intended to increase awareness of the significant differences between BED and overeating.  According to the American Psychological Association, “recurrent binge eating is much less common, far more severe, and is associated with significant physical and psychological problems.”
Anorexia Nervosa
Anorexia nervosa is characterized by emaciation, a relentless pursuit of thinness and unwillingness to maintain a normal or healthy weight, a distortion of body image and intense fear of gaining weight.  The new criteria have several minor but important changes. From the DSM-V:
“Criterion A focuses on behaviors, like restricting calorie intake, and no longer includes the word
‘refusal’ in terms of weight maintenance since that implies intention on the part of the patient and
can be difficult to assess. The DSM-IV Criterion D requiring amenorrhea, or the absence of at least
three menstrual cycles, will be deleted. This criterion cannot be applied to males, pre-menarchal
females, females taking oral contraceptives and post-menopausal females. In some cases, individuals exhibit all other symptoms and signs of anorexia nervosa but still report some menstrual activity.”
Bulimia Nervosa

Bulimia nervosa is characterized by recurrent and frequent episodes of eating unusually large amounts of food (e.g., binge-eating), and feeling a lack of control over the eating. This binge-eating is followed by a type of behavior that compensates for the binge, such as purging (e.g., vomiting, excessive use of laxatives or diuretics), fasting and/or excessive exercise.  The newly revised DSM-5 criteria reduce the frequency of binge eating and compensatory behaviors that people with bulimia nervosa must exhibit, to once a week from twice weekly as specified in DSM-IV.

See the full fact sheet from the APA here.