TPC-Journal-V4-Issue3

The Professional Counselor \Volume 4, Issue 3 252 Bulimia Nervosa The diagnosis of BN remains largely the same in the DSM-5 , although there are some modifications to the criteria. BN is characterized by repeated, uncontrollable binge-eating episodes (criterion A) accompanied by ongoing compensatory behaviors to avoid weight gain (criterion B). These behaviors to avoid weight gain include “self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise” (APA, 2013a, p. 345). The DSM-5 brings no changes to these first two criteria from the DSM-IV- TR . Also unchanged in the new edition is the fourth criterion, the following key cognitive symptom: “self- evaluation is unduly influenced by body shape and weight” (APA, 2013a, p. 345). The major change to BN in the DSM-5 is in criterion C, the frequency of the compensatory behaviors required for diagnosis. In the DSM-5 , this frequency has been reduced from an average of twice weekly to an average of only once per week. The required duration of these behaviors, however, remains the same in DSM- 5 : three months. Research indicates that individuals who display these behaviors at this new, lower threshold of once per week experience similar levels of pathology and distress (Wilson & Sysko, 2009). This decrease in frequency is likely to result in more diagnoses of BN; as stated, “increased prevalence rates are the result of a general lowering of diagnostic thresholds for eating disorders” (Dailey et al., 2014, p. 180). A secondary change to the BN criteria is the removal of the specifier regarding purging and nonpurging types of BN (APA, 2000). In the past, these specifiers described the type of compensatory behavior used by the individual. In the DSM-5 , the criterion for compensatory behavior includes both types, so no further specifier is necessary. This change reflects the research indicating that many individuals with BN regularly engage in both purging and nonpurging compensatory behaviors, making this specifier insignificant (Ekeroth, Clinton, Norring, & Birgegård, 2013; Vaz, Peñas, Ramos, López-Ibor, & Guisado, 2001). BN, like the other disorders in the DSM-5 , now has severity specifiers. For this diagnosis, the assessment of severity depends upon the frequency of inappropriate compensatory behaviors (e.g., the average number of times an individual purges in a given week). Depending on the frequency of compensatory behaviors per week, a case may be categorized as one the following: mild (1–3 episodes), moderate (4–7 episodes), severe (8–13 episodes) or extreme (14 or more episodes) (APA, 2013a). Finally, as with other disorders in the DSM-5 , clinicians can apply the specifiers of partial or full remission to BN. Binge-Eating Disorder The diagnosis of BED is new to the DSM-5 . First mentioned in the DSM-IV (Striegel-Moore & Franko, 2008), the disorder appeared in that edition and the subsequent text revision under EDNOS, with research criteria outlined in the appendices (APA, 2000). With the publication of the DSM-5 , BED was promoted from “criteria sets . . . for further study” (APA, 2000, p. 759) to being a full-fledged diagnosis. This addition is highly significant because BED is likely to be the most prevalent eating disorder (Striegel-Moore & Franko, 2008). BED shares the binge-eating criterion of BN (i.e., consuming an objectively large quantity of food in a relatively short time while experiencing a loss of control). The disorder differs from BN, however, in that individuals with BED do not engage in compensatory behaviors (e.g., vomiting or laxative use) after binge eating. An additional distinction is that BED does not include a key cognitive criterion necessary for a diagnosis of BN—the undue influence of weight and shape on self-concept (APA, 2013a). The second criterion for BED describes behaviors, emotions and cognitions associated with binge eating. The criterion includes five items and specifies that individuals must display a minimum of three to qualify for diagnosis. Examples are eating in the absence of physical hunger, eating unusually quickly and experiencing