TPC-Journal-V4-Issue3

The Professional Counselor \Volume 4, Issue 3 253 feelings of guilt and disgust around eating. Although a diagnosis of BN does require the presence of binge eating, that diagnosis does not include these additional criteria. As is the case with other eating disorders, the diagnostic criteria for BED in the DSM-5 reflect reduced requirements for duration and frequency. Whereas the research criteria in the DSM-IV-TR specified that bingeing must take place at least two days a week for six months (APA, 2000), the DSM-5 diagnostic criterion is that binge eating must occur an average of once per week, for a minimum of three months (APA, 2013a). In the DSM-5 , frequency is measured in times—rather than days—per week (for discussion, see DSM-IV-TR Appendix B, APA, 2000). In keeping with the other eating disorders, DSM-5 includes a severity specifier for BED, with, for example, between one and three episodes per week constituting mild BED, and 14 or more episodes per week qualifying as extreme (APA, 2013a). The addition of this severity rating is very helpful, as it will allow clinicians to determine the seriousness of the individual’s disorder in order to assist in treatment planning. Clinicians should also now specify whether an individual is in partial or full remission from BED. Obesity The introduction to the chapter on feeding and eating disorders explicitly addresses the decision not to include obesity as a diagnosis in the DSM-5 . This statement outlines the reasons that obesity itself does not constitute a mental disorder: “Obesity (excess body fat) results from the long-term excess of energy intake relative to energy expenditure. A range of genetic, physiological, behavioral, and environmental factors that vary across individuals contributes to the development of obesity” (APA, 2013a, p. 329). In other words, obesity is a physical condition caused by a number of contributing factors and is not, therefore, simply the embodiment of a psychological state. The introduction goes on to clarify, however, that there exist complex relationships between obesity and several psychiatric conditions. This section also refers to the connection between obesity and medications used to treat mental disorders (APA, 2013a). One of the disorders described by the DSM-5 as having a “robust association” with obesity is BED (APA, 2013a, p. 329). The relationship between obesity and BED is complicated. The manual specifies, on the one hand, that while some obese individuals suffer from BED, the majority do not. Moreover, individuals with BED are not necessarily obese; they may be overweight, or their weight may fall in the normal range (Striegel-Moore & Franko, 2008). On the other hand, obesity is a risk factor for BED (Decaluwé & Braet, 2003), and “the risk of presenting with BED increases with increasing obesity” (Hill, 2007, p. 151). One might assume that binge eating would precede obesity, but the relationship appears to move in the opposite direction (Decaluwé & Braet, 2003). Obesity also is a risk factor for the development of BN (Decaluwé & Braet, 2003; Hill, 2007). Other Specified Feeding or Eating Disorder and Unspecified Feeding or Eating Disorder Whereas the DSM-IV-TR contained the catchall diagnostic category of EDNOS, this category no longer appears in the DSM-5 . The EDNOS category previously was reserved for individuals who did not meet the full criteria for an eating disorder (e.g., a woman who meets all criteria for AN except that she has regular menses). It has been reported that this diagnosis was overly used by practitioners (Bryant-Waugh & Kreipe, 2012), so the changes in the DSM-5 attempt to address this problem. The literature indicates that many individuals who were being treated for an eating disorder received this diagnosis because they did not meet the stringent criteria for AN or BN (e.g., Sysko & Walsh, 2011). As mentioned previously, researchers have reported that EDNOS represented as many as 60% of all eating disorder diagnoses (Fairburn et al., 2007). In the DSM-5 , two new diagnostic categories replace EDNOS: other specified feeding or eating disorder and unspecified feeding or eating disorder. Other specified feeding or eating disorder refers to individuals who present symptoms characteristic of a feeding or eating disorder that causes clinically significant impairment, but