WHAT THE DSM-5 GETS WRONG ABOUT EATING DISORDERS
Written by Regina Colie
It is inevitable that as graduate students enter into the field of psychology, we will encounter the DSM-5, also known as the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders. The first edition of the DSM was published in 1952, and its purpose was to help doctors correctly diagnose psychological disorders (Fritscher, 2020).
The most recent edition, the DSM-5, was published in 2013. Psychological disorders were reviewed, edited, changed, added, and removed. The purpose of these revisions was to reflect advancements in mental health research and change the way people think about these disorders in the community (Fritscher, 2020).
As I looked through this manual, which will become more familiar to me as I prepare to see future clients, my attention went to the eating disorders section; since I plan to specialize in eating disorders as a future psychologist, I wanted to better understand the diagnostic criteria.
But as I was reading through, several issues kept appearing. For starters, the DSM-5 fails to recognize newer and current eating disorders, leading to stigmatization and misdiagnosis. Orthorexia is characterized as an individual’s obsession with eating only “healthy” or “clean” foods, while diabulimia can be harmful towards individuals who have been diagnosed with type 1 diabetes and consequently manipulate their intake of insulin to either prevent weight gain or lose weight.
Also, while examining the diagnostic criteria for OSFED, or other specified feeding or eating disorder, the criteria mentions “atypical anorexia”. This labeling can lead to fat phobia, which is shameful and degrading, and thus perpetuates structural violence and oppression in the eating disorder space.
Despite the criteria being put in place for clinicians to recognize symptoms in patients, not all disorders manifest the same way in every individual. With that being said, the current data needs to be reflected in a newer edition, as the edition as it stands actively marginalizes and fails so many people who need equitable, life-saving care.
Secondly, the language of the DSM-5, particularly with eating disorder diagnostic criteria, has a habit of oversimplifying the behaviors people with these disorders exhibit. Some of the diagnostic criteria for eating disorders is broken down through numbers and letters, depending on symptoms and severity. However, critics of the DSM-5 believe that this manual oversimplifies the complexity of human behavior (Fritscher, 2020).
Although clinicians try to avoid using diagnoses as labels, they are required to determine treatment plans for individuals. Therefore, there must be a separation between putting labels on patients and understanding their emotions as they progress through treatments. Recovery is a process that requires compassion and individualized support.
Lastly, and most importantly, the DSM needs to reflect societal pressures that can trigger struggling individuals, such as those promulgated through social media. It’s no secret that Instagram and Tik Tok have fueled the fire for promoting unrealistic body expectations through models and influencers. Despite the amount of outpouring for eating disorder awareness, this vicious cycle will continue, and treatments should reflect how this aspect needs to be taken out of the picture. If we don’t, how can we ensure healthy post-recovery habits for young people?
Although I do not wish to dismiss the DSM-5 entirely because I believe that this manual is a valuable tool for clinicians, I think that changes need to be made that are less detrimental for patients. Like every other condition covered in this manual, eating disorders are severe and must be treated adequately. However, we can’t effectively treat individuals if we still harbor ideas and theories that uphold dangerous ideas about the existence of the “stereotypical” person with an eating disorder. I hope that once I enter this field myself in the future, the DSM will be modified to serve the next generations better.
If you have a moment, please be sure to donate to my fundraising campaign! All proceeds will go towards Project HEAL’s mission. The link to my campaign can be found here: https://www.classy.org/fundraiser/3329892
Regina Colie (she/her/hers) is a Project Heal Ambassador. She is also a graduate student, getting her Masters in Clinical Mental Health Counseling (and hopefully her Ph.D!). She is looking to become a mental health counselor, and help women who are struggling with either eating disorders or postpartum depression. She is a firm believer in mental health advocacy, as well as giving women the opportunity to speak their truth.