Page 76 Complete Your CE Test Online - Click Here Here is a summary of some of the changes published in the DSM-5 as they pertain to eating disorders[1,19] : ● ● Anorexia nervosa: The criteria for anorexia nervosa remain mostly the same as in DSM-IV. Amenorrhea has been removed as a requirement for the diagnosis of anorexia nervosa. The first criterion now focuses on behaviors and no longer includes the word “refusal” in terms of weight management. The word was eliminated because it implied deliberate intention by the client and was difficult to assess. The second criterion has been expanded to include persistent behavior (behaviors) that interfere with weight gain. ● ● Bulimia nervosa: Identification of symptoms is little changed from the 4th edition of the DSM. The only change in the criteria of the 5th edition of the DSM is that the frequency of binge eating and compensatory behaviors (purging) has been reduced to just once a week. In the 4th edition, the minimum was set at twice a week. ● ● Binge-eating disorder: In the DSM-IV, binge-eating disorder was described under the category of “disorders needing further research.” In the DSM-5, binge-eating disorder has its own diagnostic label. This has been heralded by experts in the field of eating disorders, since binge-eating disorder has been used as a diagnosis for years. The criteria for binge eating are the same in both the 4th and 5th editions of the manual, except that the minimum average frequency of binge eating has been changed from at least twice a week for six months to at least once a week over the last three months. This change was made, at least in part, to be consistent with the DSM-5 frequency of the binging criterion for bulimia nervosa. Since binge-eating disorder is now classified as such in the most recent edition of the DSM, it is important that it be thoroughly discussed as part of the continuing education efforts pertaining to eating disorders. Binge-eating disorder Marlene works full time as a registered nurse specializing in neonatal intensive care. She is the assistant nurse manager and combines clinical with administrative responsibilities. Marlene is also a part- time graduate student. She is enrolled in a doctorate of nursing science program. Marlene often feels overwhelmed by the pressures of work and school. When these pressures become “too much” Marlene eats uncontrollably. These periods of overeating or binging have occurred only occasionally in the past. However, during the past three months, the episodes of binging have begun to occur more frequently, and she is starting to gain weight. David is ranked first in his high-school class of 500 students. His mother is an associate professor in the chemistry department of a large, prominent university. His father is an attorney who graduated near the top of his class at Harvard. Both parents expect David and his siblings to excel academically and follow in their footsteps as prominent professionals. David becomes extremely anxious whenever he has to take tests, knowing that his parents expect nothing less than excellence. As a way of gaining control and dealing with his feelings of anxiety, David has begun to eat large amounts of food in one sitting. Christine is 28 years old and has been married to a well-known, highly successful young executive for the past six years. Six months ago, her husband abruptly announced that he had fallen in love with someone else and wanted a divorce. Christine married immediately after graduating from college and never worked outside the home. With no work history and the need to find a way to earn a living, Christine is under a great deal of pressure. Christine feels as though her life is completely out of control. She is plagued by feelings of sadness, anger, and anxiety. When these feelings overwhelm her, she finds herself eating more and more. Lately, she has begun to eat to the point of actually developing epigastric pain. She feels unhappy and guilty about eating in this way, but is not able to control herself. This lack of control increases her feelings of stress and anxiety, which increases the cycle of binging. The preceding scenarios all describe individuals who are struggling with binge-eating disorder. For various reasons, they are experiencing significant stress and anxiety. They are all responding to this stress and anxiety by compulsively overeating in an attempt to cope with these negative feelings. Note that unlike persons who suffer from bulimia nervosa, people affected by binge-eating disorder do not participate in purging behaviors to rid themselves of excess calories. Binge-eating disorder has only recently been given its own diagnostic label in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). Prior to the publication of the most recent edition of the manual, it was described under the category of “disorders needing further research[1] .” Now that it is recognized under its own diagnostic label, healthcare professionals must work hard to be able to recognize the disorder and to support treatment initiatives that help affected persons gain control over their binging behaviors. Nursing consideration: Nurses have an opportunity to take the lead in support of those persons affected by binge-eating disorder. They may often be among the first to recognize the problem. They must also take the lead in providing objective, non-judgmental client care. Description of binge-eating disorder Binge-eating disorder, also referred to by some healthcare providers as compulsive overeating, is a newly recognized eating disorder. It is characterized[1,20] : ● ● As a serious mental illness. ● ● By uncontrollable eating, in a discrete period of time, an amount of food that is larger than what most people would eat in a similar period of time under similar circumstances. ● ● As similar to the binging that occurs in bulimia nervosa but without the accompanying inappropriate behaviors to rid the body of excess calories (purging). ● ● As a way affected persons use to cope with depression, stress, or anxiety. Nursing consideration: Persons affected by binge-eating disorder can be normal-weight, overweight, or obese[1] .However, two out of three people in the United States who have binge-eating disorder are obese[20] . Thus, binge-eating can contribute to the already significant problem of obesity in the United States. Incidence and prevalence of binge-eating disorder Binge-eating disorder has only recently been recognized as a well- defined disorder[1] . In the United States, it is estimated that about 5.6 million women and 3.1 million men have the disorder[20] . People who are obese are at greater risk for developing binge-eating disorder, but those who are of normal weight can also get it. About two of every three people in the United States who have the disorder are obese. People with binge-eating disorder may have trouble dealing with their emotions or have feelings of being out of control. They may use food as a means of consolation or reward. Attempts to engage in rigid dieting and skipping meals may actually lead to a backlash of binge eating[20] . Possible causes and risk factors of binge-eating disorder Gloria is a 20 year old college student who is a member of a large family. She has three brothers and two sisters. She has frequent contact with extended family members as well, including many aunts, uncles, and cousins as well as her grandparents. Food has always played a big part in family gatherings. Large portions are the custom, and food is often used as a means of providing comfort when problems arise or stress occurs. Gloria is moderately overweight, as are most of her family members. She has a history of dieting but seems to quickly gain back whatever weight she loses. It is difficult for Gloria to adhere to a proper weight- loss plan since her family makes fun of her when she tries to diet. The stress of family gatherings, her demanding college studies, and her negative feelings about her appearance all contribute to excessive