Diagnostic Changes for Eating Disorders in the DSM-V

Man talking with therapist specializing in eating disorder

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Considered the "bible" of the psychiatric and mental health world, the American Psychiatric Association's Diagnostic & Statistical Manual of Mental Disorders (DSM) sets the criteria needed to diagnose certain mental disorders. Diagnostic changes in new editions carry significant weight with mental health professionals, and with the release of the fifth edition (DSM-V), criteria for eating disorders underwent major changes.

In several cases, it's now easier for clinicians to diagnose someone with an eating disorder compared to the earlier edition DSM-IV-TR, which was published in 2000 and had more finite definitions. Here's a brief synopsis of the changes in the DSM-V for diagnosing eating disorders.

Binge Eating Disorder

For the first time, the DSM-V includes binge eating disorder as a fully recognized and diagnosable disorder. The DSM-IV-TR had previously included binge eating disorder as a provisional list of criteria “for research purposes.” Essentially, the previous edition had viewed binge eating disorder as too new to decipher the appropriate criteria. BED was only listed in the appendix and had to be diagnosed with the non-specific “EDNOS” (Eating Disorder Not Otherwise Specified). 

Ideally, this change should provide more validity to those who are struggling with binge eating—in which people typically eat more quickly than normal, eat until they're uncomfortably full, or eat alone out of shame at least once a week for more than three months. BED is also characterized by a feeling of a loss of control during the binge, as well as experiencing shame, distress or guilt afterwards. There is typically not purging to counter the binge eating. Hopefully, it will provide them with more coverage and treatment options, as well.

Anorexia Nervosa

The DSM-V made two major changes to the way anorexia nervosa—a condition associated with restricted food intake, fear of weight gain, and distorted body image—is diagnosed, broadening its definition:

  • Bodyweight: In the DSM-IV-TR, a person's weight had to be at or under 85% of the ideal body weight (according to the body mass index, or BMI) to be diagnosed with anorexia nervosa, thus excluding those who were suffering but hadn’t yet lost enough weight to be officially diagnosed. In the update, DSM-V qualifies diagnosis if the person has reached a “significantly low weight,” giving treatment professionals the autonomy to specify the severity of the disorder.
  • Menstruation: Previously, women had to have three or more skipped periods to be diagnosed with anorexia nervosa. Now, teen girls and women no longer have to have lost their periods (a condition technically called amenorrhea). This criteria was removed because not everyone loses their menstruation and experiences amenorrhea, but eliminating that criteria also allows males to meet the criteria for AN.

Body Mass Index (BMI) is a dated, biased measure that doesn’t account for several factors, such as body composition, ethnicity, race, gender, and age. Despite being a flawed measure, BMI is widely used today in the medical community because it is an inexpensive and quick method for analyzing potential health status and outcomes.

Bulimia Nervosa

Bulimia nervosa is characterized by purging (self-inducing vomiting or using laxatives) or non-purging (fasting or excessive exercise) behaviors, and the DSM-V's definition has changed in three significant ways:

  • Frequency of behaviors: The DSM-V criteria for bulimia nervosa require binge eating and compensatory actions to occur for at least once a week for at least three months compared to the DSM-IV-TR's definition, which had a more narrow window of at least twice a week for at least three months.
  • Categories: While the former edition listed separate classifications for the purging type of bulimia nervosa and the non-purging, these types are lumped together in the DSM-V, as clinicians now recognize that people with the disorder can engage in a variety of behaviors.
  • Phases of recovery: Professionals can currently specify whether the person is in partial or full remission from the disorder, and how severe their disorder is based on the frequency of binge and purging episodes as well as how much the disorder affects day-to-day life.

Other Types of Feeding or Eating Disorders

The DSM-V update also included two other forms of eating disorder: "other specified feeding or eating disorder" and "eating disorder not otherwise specified," which had been previously lumped together in the DSM-IV-TR as eating disorder not otherwise specified (EDNOS). Here are the ways they differ, according to the new edition:

  • Other specified feeding or eating disorder: This term is more specific and applies primarily to people with some or most of the symptoms of anorexia nervosa, bulimia nervosa, or binge-eating disorder but aren’t experiencing symptoms often enough, or haven’t been suffering long enough to qualify for a full diagnosis. It also includes purging disorder, which occurs when someone uses purging behaviors but does not engage in binge-eating behaviors (as in bulimia nervosa). To meet criteria for OSFED, a person must present with clinically significant distress and impairment, but do not meet the full criteria for any of the other disorders. Another example of OSFED is when someone meets the criteria for binge eating disorder but engages in binging behaviors at a lower frequency or a limited period.
  • Eating disorder not otherwise specified: This broader category encompasses problems that don’t fit into any current category or when the diagnosing professional doesn’t have enough information (such as in an emergency room).

Diagnostic Criteria Is a Work in Progress

It's important to note that the DSM is always, and always has been, a work in progress. There continue to be debates and disagreements among professionals about even the most current diagnostic criteria.

However, the definitions included in the DSM do provide researchers and clinicians with a language for talking about and describing sets of symptoms many people are struggling with and that need treatment.

A Word From Verywell

Eating disorders can be a complicated, emotional journey for both the person living with the disorder as well as their family and loved ones. While recovery can be a physical and mental struggle, it is possible. If you or someone you know is experiencing some or all of the symptoms of any eating disorder, please consult with a physician, dietitian, or mental health professional for assessment and treatment.

3 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. Harrington B, Jimerson,M, Haxton C, Jimerson, D. Initial Evaluation, Diagnosis, and Treatment of Anorexia Nervosa and Bulimia Nervosa. Am Fam Physician. 2015;91(1):46-52.

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Additional Reading

By Susan Cowden, MS
Susan Cowden is a licensed marriage and family therapist and a member of the Academy for Eating Disorders.