Wednesday, February 10, 2010

NPR: Binge Eating Officially Defined As A Mental Disorder

The American Psychiatric Association is releasing a new draft of its book of mental disorders Wednesday. Often described as the bible of psychiatry, this new version of the Diagnostic and Statistical Manual of Mental Disorders proposes some significant changes to classification of bipolar disorder, Asperger's syndrome, "cutting" — and binge eating.

Experts from the APA say there's now enough evidence to call binge eating a mental disorder, adding it to the group of eating disorders that includes anorexia and bulimia.

Reworking The Book Of Mental Disorders

When clinicians see a patient with mental health issues, part of their job is to determine if the patient is experiencing temporary emotional struggles or if the patient has an illness. To do this, doctors rely on the bible of psychiatry, a book called the Diagnostic and Statistical Manual of Mental Disorders. The DSM lists all the mental disorders recognized by the American Psychiatric Association.

The book is also used by insurance companies to decide which treatments they'll pay for, and by courts to help determine insanity or other mental conditions.

The APA is releasing a new draft of the DSM Wednesday, the first major revision since 1994. This latest version of the book, the DSM-V, proposes some significant changes to the following disorders:

Binge eating is defined as eating large amounts of food when you're not hungry and then feeling disgusted and depressed afterward. But most people do this from time to time. It's the frequency of a person's binge eating — and the depth of the anguish he or she feels — that raises flags.

Previously the DSM had listed binge eating in the manual's appendix, as a tentative category. Research that has come out since the last major revisions to the DSM 15 years ago justifies the classification of binge eating as a disorder in its own right, says Dr. B. Timothy Walsh, a psychiatry professor at Columbia University Medical Center and chairman of the eating disorders work group for this version of the DSM.

Some doctors treated binge eating with therapy or with medication even before it was recognized as a disorder. In some cases, a binge eater's treatment included a weight-loss regime that basically ignored the psychological aspect of the disorder.

"We're not talking intermittent overeating — that is normal — but this is recurrent, persistent, frequently occurring, accompanied by lots of distress, guilt and unhappiness," Walsh says. "We do have data that this affects a small percentage — 2 to 5 percent — of Americans throughout their lifetime."
Researchers and doctors still don't really know what causes these issues, he says, and various factors appear to contribute.

"There's no consensus as to what is the best treatment," Walsh says. "Several types of medications appear helpful, as do several types of psychological treatment."

Binge eating is associated with middle-aged men and women, and it is not always linked with obesity. That's why treatments that address weight loss alone aren't necessarily helpful, Walsh says. He is hopeful that the categorization of binge eating as a disorder will stimulate further research. In particular, he says, he'd like to see some study of how mental health treatments for binge eating affect a patient's outcome.

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