Introduction

Beginning with DSM-III-R, there has been a section in DSM devoted to Eating Disorders. In DSM-IV, criteria are provided for two disorders, Anorexia Nervosa and Bulimia Nervosa. A residual category, Eating Disorder Not Otherwise Specified (EDNOS) is provided for eating disorders not meeting criteria for one of these. In addition, in an appendix, DSM-IV provided provisional criteria for a specific form of EDNOS, Binge Eating Disorder.  

Charge to the Work Group

The work group was asked to review, critique, and suggest revisions to the existing diagnostic criteria for Eating Disorders, and for Feeding and Eating Disorders of Infancy or Early Childhood (Pica, Rumination Disorder, Feeding Disorder of Infancy or Early Childhood). In addition, the work group was asked to consider whether obesity should be considered for inclusion in DSM-V. 

Major Issues

A major problem with the existing criteria identified by the work group and widely discussed in the field, is the very high frequency of use of EDNOS in clinical settings. This issue overlaps with the important questions regarding whether it would be appropriate and useful to formally recognize additional categories in DSM-V, such as Binge Eating Disorder, Purging Disorder and Night Eating Syndrome. 

A second major issue relates to the utility and validity of the current criteria provided to categorize feeding and eating disorders of infancy and early childhood. This topic has received somewhat less attention in the literature, leading to significant uncertainty regarding the needs for and best approach to revisions.  

Approach

The members of the work group are completing 13 focused literature reviews relevant to the major issues areas noted above. Most of the reviews are in near-final form. They are currently undergoing final review by members of the work group and it is expected that these will be submitted for publication in the immediate future. It is hoped that they will be published and widely available for review by the field and for commentary within the next 12 months. The reviews explicitly discuss a range of options for possible change to the criteria for eating disorders in DSM-V. 

The work group has begun to consider potentially useful dimensions that might be included in DSM-V to assess the “traditional” eating disorders. The most promising candidates discussed to date are: BMI, frequency of binge eating, frequency of purging, and overconcern with shape and weight. 

The work group’s efforts are substantially aided by an R13 grant from NIMH (PI: S. Wonderlich), which has supported two meetings of investigators with data sets relevant to the diagnosis of eating disorders. The second of these took place in March, 2009, and focused on three topics: (1) Eating and Feeding Disorders in Children and Young Adolescents; (2) Impact of Culture on Eating Disorder Classification; and, (3) The Validity and Utility of Binge Eating (as a diagnostic term).  

Four advisors have been appointed to assist the twelve members of the work group and to review some of the most challenging areas under consideration. The work group continues to consult with other work and study groups reviewing topics of mutual interest. 

In order to obtain commentary and suggestions from clinicians and investigators, members of the work group are presenting a summary of the efforts to date at the Spring, 2009 meeting of the Academy for Eating Disorders and at the meeting of the Eating Disorders Research Society in September, 2009.