Fairburn on the DSM's shortcomings

The Oxford scholar Christopher Fairburn would have to be considered one of the world's foremost authorities on eating disorders. His bio includes:  twice a fellow at Stanford's Center for Advanced Study in the Behavioral Sciences; fellow of the UK Academy of Medical Sciences; a governor of the Wellcome Trust, the largest international biomedical research foundation; recipient of the 2002 Outstanding Researcher Award by the Academy for Eating Disorders.

He is not, however, a believer in food addiction, so I rarely find myself cheering him on. But this abstract that just appeared in the British Journal of Psychiatry did have that effect. It begins:

The DSM–IV scheme for classifying eating disorders is a poor reflection of clinical reality. In adults it recognises two conditions, anorexia nervosa and bulimia nervosa, yet these states are merely two presentations among many.

For those who don't know, the DSM is the Diagnostic and Statistical Manual of the American Psychiatric Association, and it catalogues the group's accepted diagnoses. It is currently in its fourth revision, with a fifth one well under way. Binge-eating disorder appears very likely to be added as a third food substance use disorder; food addiction will not be added. Yet.


The changes proposed for DSM–5 will only partially succeed in correcting this shortcoming. With DSM–6 in mind, it is clear that comprehensive transdiagnostic samples need to be studied with data collected on their current state, course and response to treatment.


I've been reflecting some on the addition of BED, since clearly, I was an active binge eater for well more than a decade. I do think the DSM V will do a better job of reflecting my reality than the DSM VI does.

I just don't think it will go far enough. My problem eating goes beyond binge eating, just as it goes (much further) beyond anorexia and bulimia. That deficit is reflected in clinical practice, in that up until now, about half the eating disorder diagnoses have fallen into the ED-NOS category (eating disorders-not otherwise specified). When your catch-all is the most-invoked category, your categories needed fixin'.

(This would probably be a good place for my usual disclaimer, that I'm not a scientist, so the more specific I get, the more I am treading on others' turf. I'm also wont to add, however, that it's possible that those who govern the DSM have not tread sufficiently on my turf, since they appear not to understand my experience.)

Prof. Fairburn points out the obvious failing of the categories is his article, and calls for more research. Alas, I have no reason whatsoever to think that his position on food addiction is changing. Even so, I'm delighted to highlight a point of common ground with him.

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