Both the DSM-IV and the International Classification of Diseases, tenth edition, or ICD-10, are set to undergo significant changes. Drs. Rudolf Uher and Michael Rutter, of King’s College, London and Dalhousie University, Halifax, Nova Scotia, feel that the ICD’s classification of feeding and eating disorders particularly needs updating (World Psychiatry 2012;11:80).

The researchers have pointed out four major concerns about the ICD-10. First, the majority of patients presenting with eating-related psychopathology do not fulfill criteria for a specific disorder and are instead classified in “other” or “not otherwise specified” categories. Next, most individuals with an eating disorder sequentially receive several diagnoses instead of a single diagnosis that would describe the person’s problems at various developmental stages. Third, most recent clinical trials have used modified diagnostic criteria that may better reflect clinical practice but deny the purpose of the classification as a means for communication between clinicians and researchers. Finally, although childhood feeding disorders are typically described in the history of teens and adults with eating disorders, there is little research on the developmental continuity between childhood, adolescent, and adult disorders that involve aberrant eating behaviors.

Recommended changes

The authors made 8 major recommendations for the classification of feeding and eating disorders in the ICD-11:

1. Merge feeding and eating disorders into a single grouping, with diagnostic categories available for all age groups.
2. Broaden the category of anorexia nervosa (AN) by dropping the requirement for amenorrhea, extending the weight requirement to include any significant underweight, and extending the cognitive criterion to include developmentally and culturally relevant conditions and behavioral equivalents of fear of fatness, preoccupations with body weight and shape or food and eating.
3. Introduce a means of qualifying severity “with a dangerously low body weight” to distinguish most severe cases that carry the riskiest prognosis within the broad category of AN.
4. Broaden the category of bulimia nervosa (BN) to include subjective binge eating.
5. Include the category of binge eating disorder (BED), defined by either subjective or objective binge eating in the absence of regular compensatory behaviors.
6. Create a category of Combined Eating Disorder to classify subjects who concurrently or sequentially fulfill the criteria for both AN and BN.
7. Introduce a category of Avoidant/Restrictive Food Intake Disorder (ARFID) to classify restricted food intake that is not accompanied by body weight- and shape-related psychopathology.
8. Introduce a uniform minimal duration criterion of 4 weeks.

After nearly 2,300 recommendations, the DSM-V will be published in May 2013, while the ICD-11 will be finalized in 2015.