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“I’m a crusader for being yourself and loving yourself but I’ve found it hard to practice,” pop music star, Ke$ha, wrote on her Facebook page in early January 2014. “I’ll be unavailable for the next 30 days, seeking treatment for my eating disorder…to learn to love myself again.”
Hearing that another celebrity has entered treatment for an eating disorder might not surprise anyone. What is astounding, though, are the national statistics regarding feeding and eating disorders:
- 20 million women and 10 million men will experience a clinically significant eating disorder at some point in their lifetime
- Currently, as many as 8 million people are living with an eating disorder
- Among the U.S. population, 50 percent of people know someone with an eating disorder
The American Psychiatric Association (APA) released the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in May 2013. Commonly referred to as the “bible of psychiatry,” this edition of the manual, with its extensive updates and changes to many mental disorders, has received both high praise and intense criticism.
The chapter on feeding and eating disorders in the DSM-5 has been at the top of the controversial list.
DSM-5 Feeding and Eating Disorder Controversies
One of the most passionate debates has to do with the APA’s addition of the new binge eating disorder. In the DSM-IV, binge eating fell into the category of eating disorder not otherwise specified (EDNOS). Previously, it was recognized only as a symptom used in diagnosing a range of different eating disorders.
“EDNOS captures people that don’t really fit into anorexia or bulimia,” said Lara Gregorio in an interview with the Huffington Post. Manager of the National Eating Disorder Association, Gregorio claims that as many as 50 percent of people diagnosed with an eating disorder were lumped into the EDNOS category. She, along with other experts, felt that such a general diagnosis made it difficult for patients to receive proper treatment.
In the DSM-5, a person who eats excessively at least once a week in a three-month period meets the clinical criteria for binge eating disorder.
Critics of the new binge eating disorder, like psychiatry professor emeritus at Duke University, Dr. Allen Frances, complain that this diagnosis has the tendency to over-pathologize behavior. In his interview with Slate, Dr. Frances referred to binge eating disorder as one of the “top 10 changes to be ignored,” and that the DSM-5 turns gluttony into a mental disorder.
Here’s a list of some of the other changes to the feeding and eating disorders section of the DSM-5:
- A decrease in the number of purging episodes a person must have in a week in order to be considered bulimic
- A woman or a girl no longer has to lose her period in order for a diagnosis of anorexia
- The word “refusal” in reference to weight maintenance was removed because it implied intention on the part of a patient diagnosed with anorexia
- The requirements for pica, a disorder where patients have an appetite for non-nutritive substances such as clay, sand, chalk or dirt, have been modified to now refer to people of any age
Substance Abuse and Eating Disorders
The numbers on alcohol or drug abuse in people suffering from eating disorders are much higher than expected. Research estimates that as many of 50 percent of patients with an eating disorder are struggling with substance abuse and dependency issues. This can also include addictions to over the counter drugs, such as diet pills, laxatives and weight loss supplements.
While treatment facilities that only handle eating disorders can be effective, they might not be equipped to handle a both co-occuring disorders of substance abuse and eating disorders. When considering treatment for eating disorders combined with substance abuse, it is important to do research, and seek care at a treatment center where both conditions can be addressed.