Classification and epidemiology of eating disorders in the DSM-5

In May 2013 the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has been published, which includes a substantially revised section on feeding and eating disorders. Throughout the DSM-5 the inşuence of development, gender and culture on the presentation of psychiatric disorders has been given more weight than any previous edition of the DSM ever did, and wherever possible it seeks to adhere to a lifespan appro. One of the consequences of the lifespan approach is the elimination of the prior DSM-IV chapter “Disorders Usually First Diagnosed During Infancy, Childhood or Adolescence.” As a result of the removal of this chapter, the two separate categories “Feeding Disorders” and “Eating Disorders” from DSM-IV are integrated into a single category called “Feeding and Eating Disorders” in DSM-5 This DSM-5 chapter “Feeding and Eating Disorders” includes the following diagnoses: pica, rumination disorder, avoidant/restrictive food intake disorder, anorexia nervosa (AN), bulimia nervosa (BN) and binge eating disorder (BED). Eating Disorders Not Otherwise Specified (EDNOS) was a major concern for the DSM-5 Eating Disorders Work Group, because it was by far the most common DSM-IV eating disorder diagnosis not only in community samples, but it also accounted for more than half of the eating disorder cases in clinical settings. The use of DSM-5 criteria will result in a large reduction in the proportion of EDNOS diagnoses by lowering the threshold for AN and BN and adding BED as a specific eating disorder. In consequence the prevalence rates for AN and BN will increase, but course and outcome studies of both AN and BN indicate no significant differences between DSM-5 and DSM-IV definitions. The lifetime prevalence of DSM-5 anorexia nervosa among women might be up to 4%, and of bulimia nervosa 2%. In a cross-national survey, average lifetime prevalence of binge-eating disorder was 2%. Community studies show that most people with eating disorders do not receive any treatment at all, either because they are not detected or because they refuse treatment due to shame or denial of their illness.