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, appendix B of DSM-IV (Criteria Sets and Axes Provided for Further Study) 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. 

Identification of Issues

In its first meetings, the work group considered commonly held views of the advantages and disadvantages of the current nomenclature for eating disorders. There was general agreement that the traditionally defined eating disorders, Anorexia Nervosa and Bulimia Nervosa, were clinically useful. The major problem with the existing criteria, widely discussed in the field, is the very high frequency of use of EDNOS in clinical settings. This issue overlaps with the important question of whether Binge Eating Disorder is a valid and useful diagnostic entity. In addition, other “atypical” variants of the recognized eating disorders have been suggested, such as Purging Disorder and Night Eating Syndrome. The designation of obesity as a mental disorder would be a major and controversial change. 

The work group also noted concerns about the specifics of the current criteria, for example, whether amenorrhea should be required for the diagnosis of Anorexia Nervosa, whether an average frequency of binge eating and the use of inappropriate compensatory behaviors of twice per week for three months should be required for Bulimia Nervosa, and whether the wording of several criteria reflects the range of phenomena seen across cultures and among younger patients. 

Finally, there is uncertainty about the utility and validity of the current criteria provided to categorize feeding disorders of infancy and early childhood. 

Approach

The members of the work group are conducting 11 focused literature reviews on the areas noted above; all reviews are in draft form, and several are nearly final. The target date for their completion, and for preliminary suggestions regarding options for change, is January 2009. These will be published so that they may be critically reviewed, examined in clinical settings, and revised accordingly during 2009 and 2010.  

The work group’s efforts are substantially aided by an R13 grant from NIMH, which will support two meetings of investigators with data sets relevant to the diagnosis of eating disorders. The first of these took place in September 2008, and focused on three topics: (1) Are there empirical data to support grouping all clinically significant eating disorders into several broad categories? (2) Are there empirical data to clarify the composition of the EDNOS category and possibly support additional specific eating disorders, such as Purging Disorder? (3) What empirical data support the clinical validity of Binge Eating Disorder? The next R13 meeting will occur in early 2009. Preliminary topics to be addressed at that meeting will include a review of empirical data regarding feeding disorders of infancy and early childhood, the clinical validity of “binge eating”, and the influence of culture on the clinical presentation of eating disorders.  The work group is consulting with other work groups reviewing topics of potential diagnostic overlap. 

Finally, the work group is actively reaching out to clinicians and investigators to solicit their thoughts and suggestions. For example, most members of the work group will attend the next meeting of the Academy for Eating Disorders in Spring, 2009 and have proposed a workshop session to present current thinking and obtain feedback. Information about the work group and its plans has been distributed to the Academy's newsletter and to all members of the Eating Disorders Research Society via email.