Binge Eating: A Disorder? More DSM-5 Troubles
Posted by Dr. Vollmer on May 11, 2010
Binge Eating Disorder is likely to hit DSM-5. http://www.dsm5.org/ProposedRevisions/Pages/EatingDisorders.aspx. Once again, psychiatry has lost its’ way. Since when does a symptom become a diagnosis? To say that binge-eating is a disorder is like saying a headache is a disorder. A headache, like binge-eating is a symptom of underlying distress in which the physician must explore the underlying cause. Is it a brain tumor? The sinuses? Stress? Neck problems? A migraine? The symptom of the headache is the jumping off point to curiosity and exploration. Binge eating is the same thing. Is it anxiety? Is it sexual discomfort? Is it depression? Is it bad habits? By making binge eating a “disorder” psychiatrists are discouraging the discovery of the person’s interior life. HELP!
Shirah Vollmer MD 
Shelly said
What is the psychiatric definition of a disorder?
Thanks.
Dr. Vollmer said
Good question. A mental disorder is a psychiatric diagnosis which is a cluster of symptoms resulting in impaired social and occupational functioning. My point is that a symptom is not the same as a disorder.
Kristin said
I agree that it is distressing that the DSM-5 might be discouraging mental health professionals from trying to discover the mental lives of their patients, and instead encouraging them to treat symptoms only. But when the factors leading to certain symptoms are so varied and complex, might it not be useful to also include symptom-based entries in the DSM-5 so that practitioners could have criteria for determining whether the particular symptoms are in fact over some defined threshold that demands attention? For example, I could imagine a non-specialist — say a family medicine doctor — wondering if an overweight patient’s confession of downing a pint of Haagen Daaz in a single setting once a week signals a mental health issue that needs particular attention, and I could imagine that the DSM might be a convenient source for answers to those kinds of questions. I’m a lay person, so I don’t really know what I am talking about, but I enjoy thinking about the issues posed in your blog. I find the whole concept of the DSM fascinating.
Dr. Vollmer said
OK. So we should have a book entitled “symptoms which warrant a referral to a mental health professional.” In this, we can have binge-eating, trouble sleeping, problems with relationships, etc. We should not have a book that enables a physician, of any stripes, to take a symptom and give a patient a diagnosis of a mental disorder. Does every vice translate into a mental illness? I hope not.