BED in the DSM

I've been remiss in reporting a key development in the fight for public recognition of food addiction: The Diagnostic and Statistical Manual of the American Psychiatric Association, whose statute allows it to say what is a mental illness and what isn't, has indeed included binge-eating disorder in its fifth edition.

Longtime readers of this blog will know I've been discussing the DSM for four or five years, looking forward to this revision. Heretofore, the DSM had listed only three eating disorders: anorexia, bulimia, and EDNOS (eating disorders not otherwise specified), which is less a catch-all than slightly less stringent definitions of the other two illnesses.

I have been advocating that food addiction be added to that list, because once a condition is certified by the APA, insurance companies will pay for its treatment. Longtime readers will also know that in 1991, a different era of healthcare funding, I spent nine weeks in the eating-disorders unit of a Long Island rehab hospital, and it was a vital turning point in my life. Every year, I mark October 21, the day I entered, as my re-birthday, and in 2010, it was the day I released "Fat Boy Thin Man," which has an entire chapter on the experience.

So why, then, did I let the announcement slip by without trumpeting it? A couple of reasons.

First, I'm sometimes guilty of missing historical change, when it arrives in slight increments. There have been indications that BED would make it for a couple of years. I went to a party this summer for BED advocates to celebrate its inclusion, even though it wasn't official. So by the time it was, it was old news to me. But it's news, nevertheless, and I'm late with it.

Second, binge-eating disorder does not fully equate with food addiction. It is a subsection, just as anorexia and bulimia are. I am a binge eater, clearly, and certainly to a far greater extent, BED describes my experience better than anorexia and bulimia do.

(Although: When I was in rehab, one of the certainties I learned is that I'm an anorexic, except I have never restricted, and I'm a bulimic, except I've never purged. If it seems, to you, that those ideas are nonsense, it's OK; it just means you haven't benefitted from the enlightenment I have. The full experience of those diseases includes a range of feelings and twisted conceptions beyond just the restricting or purging, and I found that I shared them.

(A couple of examples, just to illustrate: I was prone to isolation, so I could be freely active in my disease. And, I would even forego social opportunities I found attractive, if it meant I wouldn't be able to use food the way I was driven to.)

These and other substantial commonalities are why I think the proper classification is food addiction, not the subsets. The approved classifications are defined by the food behaviors, which leaves out not only the connective tissue, but also the essence of addiction, which is a biochemical sensitivity. The American Society of Addiction Medicine recognizes this and includes food as an addictive substance.

So, from my perspective, the fight is not won. But perhaps the key battle has been. If I'd reached the low point of my disease in, say, six months or a year later than I did, managed care might have prevented me from experiencing the vital turning point of my life. Someone like me reaching that point today will have the BED diagnosis with which to get help.

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