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      Eating disorders, DSM–5 and clinical reality

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      Author(s): , DM, FMedSci, FRCPsych, , DPhil, Dip Psych
      Publication date PMC-release:
      Journal: The British Journal of Psychiatry
      Publisher: Royal College Of Psychiatrists

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          Abstract

          The DSM–IV scheme for classifying eating disorders is a poor reflection of clinical reality. In adults it recognises two conditions, anorexia nervosa and bulimia nervosa, yet these states are merely two presentations among many. As a consequence, at least half the cases seen in clinical practice are relegated to the residual diagnosis ‘eating disorder not otherwise specified’. The changes proposed for DSM–5 will only partially succeed in correcting this shortcoming. With DSM–6 in mind, it is clear that comprehensive transdiagnostic samples need to be studied with data collected on their current state, course and response to treatment. Only with such data will it be possible to derive an empirically based classificatory scheme that is both rooted in clinical reality and of value to clinicians.

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          Eating disorder NOS (EDNOS): an example of the troublesome “not otherwise specified” (NOS) category in DSM-IV

          Christopher Fairburn, Kristin Bohn (2005)
          The “Not Otherwise Specified” (NOS) category within DSM-IV is designed for disorders of clinical severity that are not specified within broad diagnostic classes. “NOS” diagnoses are intended to be residual categories and they tend to be neglected by researchers. This can be inappropriate. The problems associated with certain NOS diagnoses are well illustrated by “Eating Disorder NOS” (sometimes termed EDNOS), which is the most common category of eating disorder encountered in routine clinical practice yet it has barely been studied. Indeed, there has been no research on its treatment. Interim and longer-term conceptual and practical solutions to the anomalous status of eating disorder NOS are proposed including the creation of a new diagnosis termed “mixed eating disorder”. Several of these solutions are of relevance to NOS categories in general. All the solutions should fulfil criteria for clinical utility.
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            The validity and clinical utility of binge eating disorder.

            Stephen A. Wonderlich, Annette Engel, Jacy R. Crosby … (2009)
            This review attempted to examine the validity and clinical utility of the DSM-IV binge eating disorder (BED) diagnosis across a wide range of validating strategies. Various electronic databases (Pub Med, Psych Info) were searched for terms relevant to the diagnosis of BED (e.g., binge eating disorder, binge eating) in order to identify papers. Additionally, published papers were reviewed in order to locate additional manuscripts and papers that were presented at meetings. The validity and utility of BED varied substantially according to the validator chosen. There is reasonable evidence that BED can be differentiated from other existing eating disorders and is associated with significant impairment and clinical levels of eating disorder psychopathology. The relationship of BED to obesity is complex, and in spite of some positive findings, further research examining the predictive power of BED, beyond the simple presence of obesity and associated psychopathology, in relationship to clinically relevant outcomes is needed. Binge eating disorder is being considered for inclusion in the DSM-V and various options regarding this decision are reviewed based upon the empirical findings in the paper.
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              The severity and status of eating disorder NOS: Implications for DSM-V

              Christopher Fairburn, Zafra Cooper, Kristin Bohn … (2007)
              “Eating disorder NOS” is the most common eating disorder encountered in outpatient settings yet it has been neglected. The aim of this study was to describe the characteristics of eating disorder NOS, establish its severity, and determine whether its high relative prevalence might be due to the inclusion of cases closely resembling anorexia nervosa or bulimia nervosa. One hundred and seventy consecutive patients with an eating disorder were assessed using standardised instruments. Operational DSM-IV diagnoses were made and eating disorder NOS cases were compared with bulimia nervosa cases. Diagnostic criteria were then adjusted to determine the impact on the prevalence of eating disorder NOS. Cases of eating disorder NOS comprised 60.0% of the sample. These cases closely resembled the cases of bulimia nervosa in the nature, duration and severity of their psychopathology. Few could be reclassified as cases of anorexia nervosa or bulimia nervosa. The findings indicate that eating disorder NOS is common, severe and persistent. Most cases are “mixed” in character and not subthreshold forms of anorexia nervosa or bulimia nervosa. It is proposed that in DSM-V the clinical state (or states) currently embraced by the diagnosis eating disorder NOS be reclassified as one or more specific forms of eating disorder.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Br J Psychiatry
                Journal ID (publisher-id): bjprcpsych
                Journal ID (hwp): bjp
                Title: The British Journal of Psychiatry
                Publisher: Royal College Of Psychiatrists
                ISSN (Print): 0007-1250
                ISSN (Electronic): 1472-1465
                Publication date (Print): January 2011
                Publication date PMC-release: January 2011
                Volume: 198
                Issue: 1
                Pages: 8-10
                Affiliations
                Oxford University Department of Psychiatry, Warneford Hospital, Oxford, UK
                Author notes
                Correspondence: Christopher G. Fairburn, Oxford University Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX, UK. Email: credo@ 123456medsci.ox.ac.uk
                Article
                Publisher ID: 0008
                DOI: 10.1192/bjp.bp.110.083881
                PMC ID: 3014461
                PubMed ID: 21200070
                SO-VID: 56a37aa6-b5da-4e42-80cd-63cfedb8c67d
                Copyright © Royal College of Psychiatrists
                License:

                This paper accords with the Wellcome Trust Open Access policy and is governed by the licence available at http://www.rcpsych.ac.uk/pdf/Wellcome%20Trust%20licence.pdf

                History
                Date received : 18 June 2010
                Date revision received : 26 August 2010
                Date accepted : 9 September 2010
                Categories
                Subject: Reappraisal

                ScienceOpen disciplines: Clinical Psychology & Psychiatry
                Data availability:
                ScienceOpen disciplines: Clinical Psychology & Psychiatry

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