Abstract
Proposed changes to the classification of bulimic-type eating disorders in the lead up to the publication of DSM-5 are reviewed. Several of the proposed changes, including according formal diagnostic status to binge eating disorder (BED), removing the separation of bulimia nervosa (BN) into purging and non-purging subtypes, and reducing the binge frequency threshold from twice per week to once per week for both BN and (BED), have considerable empirical evidence to support them and will likely have the effect of facilitating clinical practice, improving access to care, improving public and professional awareness and understanding of these disorders and stimulating the additional research needed to address at least some problematic issues. However, the omission of any reference to variants of BN characterized by subjective, but not objective, binge eating episodes, and to the undue influence of weight or shape on self-evaluation or similar cognitive criterion in relation to the diagnosis of BED, is regrettable, given their potential to inform clinical and research practice and given that there is considerable evidence to support specific reference to these distinctions. Other aspects of the proposed criteria, such as retention of behavioral indicators of impaired control associated with binge eating and the presence of marked distress regarding binge eating among the diagnostic for BED, appear anomalous in that there is little or no evidence to support their validity or clinical utility. It is hoped that these issues will be addressed in final phase of the DSM-5 development process.
Highlights
Proposed changes to the classification of bulimic-type eating disorders in the lead up to the publication of DSM-5 are reviewed
Readers may observe that reference to variants of bulimia nervosa (BN) characterized by “repeatedly chewing and spitting out, but not swallowing, large amounts of food” as an exemplar of the EDNOS category has been abandoned in DSM-5. This change presumably reflects the perception that these behaviors, which have been observed among individuals with both anorexia nervosa (AN)-type and BN-type disorders, are no longer of sufficient importance, in terms of their prevalence and/or clinical significance, to warrant specific mention, there appears to be little in the way of empirical evidence to support such an assumption [71,72]
Proposed changes to the DSM diagnostic criteria for bulimic-type eating disorders in the lead up to the publication of DSM-5 will go some way to facilitating clinical practice, improving access to care, improving public and professional awareness and understanding of these disorders and stimulating the additional research needed to address at least some problematic issues
Summary
All of the criteria for Bulimia Nervosa are met except that the binge eating and inappropriate compensatory mechanisms occur at a frequency of less than twice a week or for a duration of less than 3 months. All of the criteria for Bulimia Nervosa are met, except that the binge eating and inappropriate compensatory behaviors occur, on average, less than once a week and/or for less than for fewer than for 3 months. 4. The regular use of inappropriate compensatory behavior by an individual of normal body weight after eating small amounts of food (e.g., self-induced vomiting after the consumption of two cookies). All of the criteria for Binge Eating Disorder are met, except that the binge eating occurs, on average, less than once a week and/or for fewer than for 3 months. Chewing and spitting out, but not swallowing, large amounts of food
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