Binge eating promoted 'to front of the book' in DSM-5; obesity rejected

PHILADELPHIA — Binge eating will be recognized as a legitimate syndrome in the updated Diagnostic and Statistical Manual of Mental Disorders, fifth edition, according to researchers who presented here at the 2012 American Psychiatric Association Annual Meeting. Obesity, however, will not be included, they said.

B. Timothy Walsh, MD, chair of the work group assigned to update eating disorders criteria in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), said there are reliable data suggesting that those with eating disorders have higher rates of anxiety and depression and that those patients do not respond well to routine treatments for overweight and obesity.

“On the basis of these extensive data, we recommended that the binge eating disorder be promoted to the front of the book,” he said.

The current DSM only recognizes two eating disorders: anorexia nervosa and bulimia nervosa. Eating disorders not otherwise specified (NOS) include purging disorder, night eating syndrome and binge eating.

Walsh said the frequency and prominence of binge eating was a major consideration in updating the diagnostic criteria.

“The major problem across eating disorders was the high frequency of the use of NOS, often quoted as above 50% — and not wrongly quoted as being above 50% in some centers,” he said. “This territory has been one of the poster children for the overuse of NOS.”

Walsh said the solution was obvious: “We can broaden the existing criteria and recognize new disorders.”

To investigate the clinical utility of revising the criteria of eating disorders, the 12-member DSM-5 work group completed 13 literature reviews, which were published in 2009. However, according to Walsh, the literature was not supportive of including obesity as a mental disorder. Obesity was best viewed as a medical condition resulting from complex interaction between the environment and the individual’s psychobiological characteristics.

“A crude analogy would be homelessness,” he said. “People are homeless for a number of reasons, including psychological and behavioral problems. But I don’t think it would be a good idea to include homelessness as a psychological disorder.”

Walsh said he and members of the DSM-5 task force will continue to debate the importance of the underlying neurological similarities between obesity and other eating disorders and substance abuse disorders.

To view draft revisions in the DSM-5, visit www.dsm5.org.

For More Information:
DSM-5. Symposium S044.4. Presented at: the 2012 American Psychiatric Association Annual Meeting; May 5-9, 2012; Philadelphia.

Disclosure: Dr. Walsh and members of the work group report receiving research support from AstraZeneca.