While I am on the topic of the DSM process, it may be of interest to some readers that the American Psychiatric Association has posted some of its proposed changes to the old DSM-IVTR edition on this revision site. Until some time in April (no not April Fools) they are leaving the changes out for view, and supposedly comments. I will be commenting here from time to time; I haven’t decided if I will comment there, as I am no longer sure I want to invest any more time in that system, which refuses to make the kinds of changes that McHugh advocates (see the previous post). Today I will touch on eating disorders, and how they have been insidiously degraded, by the new changes. Again these are my personal opinions, and not a professional treatise.
In the new field guide, they propose to make it easier to spot this disorder, because the occasional binge-purger will now qualify, making it more like a personality disorder than an illness. Will the weekend binge drinker, who now purges the bar food up most Saturday nights, qualify? By numbers they certainly will, So now there will be more money for psychiatry, and more diagnostic muddle for serious researchers.
Another change in DSM-5, in Eating Disorders, which will similarly muddle any diagnostic clarity, is combining the subtypes. In DSM-IIIR, when I was on the Ad Hoc Panel there, they combined useful subtypes of Conduct Disorder, when most of us argued for more refined distinctions. The result then was a diagnosis too broad to be of much use or interest to serious researchers. The same thing likely goes with this, I am curious what other clinicians and researchers think.
Instead, we should be sharpening the clarity beyond the “field guide” approach, to look at variables that might some day shed a light on this disorder. Tension regulation. Co-morbid addictions. Family patterns. Adjustment. This list goes on..DSM doesn’t want you to have to think.