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The DSM-5: good news

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The DSM-5 is the latest version of the American Psychiatric Association's "Diagnostic and Statistical Manual of Mental Disorders." It's used by mental health professionals in the U.S. to diagnose mental health problems. It is also used to categorize patients for research purposes. The DSM was originally published in the 1950s; the last major revision (the DSM-4) was in 1994.

You may be aware that obesity, binge eating disorder, and "overeating" were up for inclusion in the new edition. The good news: binge eating disorder made it in and obesity and overeating didn't.

Binge eating disorder is a widely recognized mental health issue. We've talked about it at BFB before. It is characterized by episodes of eating a very large amount of food until over-full without enjoying it, and while feeling out of control. The diagnostic criteria are in the article I linked to, and they sound reasonable to me. Of course, I'm not an expert.

Until now, binge eating disorder has been included in EDNOS: Eating Disorders Not Otherwise Specified. Now it has its own category. This will make it easier to diagnose and treat and will make insurance coverage more likely for people seeking help. Most people will probably agree that this is a good thing.

In contrast, obesity is defined by BMI, which is basically a weight/height ratio. It is influenced to some extent by behavior, but is 40-80% a result of genetics. Also (and this might be what made the difference) the obesity label doesn't distinguish between muscle and fat. So, while most fat people are classified as obese, so are many bodybuilders and professional athletes. And, of course there's a huge middle range of people who are varying degrees of muscular while also being varying degrees of fat. The idea that all of these people have a mental health problem that can be defined by their BMI is completely absurd. I'm glad that this was ultimately recognized, but I'm also stunned that adding obesity to the DSM-5 was even considered.

I'm not sure how they were defining "overeating," but I suspect that they wanted to use it as a behavior-based proxy for obesity and then discovered that according to the research, the two are either weakly or not at all linked.

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