The “DSM-5” and Obesity, Part 1

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We’ll get to the obesity relevance in a minute, but meanwhile, here is an interesting detail about the upcoming revised edition of the Diagnostic and Statistical Manual of Mental Disorders. The Roman numerals are being dropped in favor of Arabic numbers, so the new version will actually be DSM-5. Another footnote of interest: the third edition of the DSM was edited by Dr. Robert Spitzer, who coined the term “pathological overeating syndrome,” which applies to obese people who binge-eat and differentiates them from obese people who habitually overeat but don’t binge.

Last week, we looked at some of the characteristics of comfort eating and how it can lead to obesity in all age groups, and, especially, how it can morph into a condition with all the earmarks of classical substance addiction, i.e. food addiction. Some healthcare professionals, including Dr. Pretlow, think the DSM should recognize food addiction as a true addiction. This is a controversial position to take. Many medical professionals resist the Psychological Food Dependence-Addiction Paradigm and its importance in the quest to end childhood obesity. To break down the resistance, it is necessary to first understand it.

Gary Greenberg is a practicing psychotherapist and the author of Manufacturing Depression: The Secret History of a Modern Disease. In Wired magazine, he describes the Diagnostic and Statistical Manual:

The book is the basis of psychiatrists’ authority to pronounce upon our mental health, to command health care dollars from insurance companies for treatment and from government agencies for research. It is as important to psychiatrists as the Constitution is to the US government or the Bible is to Christians.

The volume is compiled by the American Psychiatric Association, and the work is done by 13 panels that have been meeting since 2008 to hash out the final content of the forthcoming edition. They get plenty of input from other sources, notably 8,000 electronically-submitted comments.

The DSM is the ultimate authority not only for healers of the body and the mind, but for bureaucrats and lawyers. When it comes to a highly specialized area like juvenile forensic psychiatry, every word of the proposed text is hotly debated by such articulate practitioners as Karen Franklin. The interpretation and application of those words can be the factor that decides whether a person gets treatment he or she needs, or a prison sentence (or a death sentence).

Childhood obesity seems less dire than execution, but it can lead just as surely to undesirable outcomes including a premature demise. And before it kills, it’s a huge quality-of-life issue. So, what the DSM says about it will ultimately affect a lot of people. No matter which particular section of the book is being discussed, there are generally two opposing schools of thought.

One camp feels that a lot of diseases have been invented for the benefit of the pharmaceutical corporations. There is a field called epidemiology, and experts in it have remarked that if you go by the DSM, 30 percent of Americans are mentally ill. Over time, some get better and some get worse, but at any given moment, it’s nearly one-third of our total population, and this is seen in some quarters as gross over-diagnosis. Some are very alarmed about the number of pills being swallowed by children across the land, to treat conditions that could be better treated without medication, or just maybe are not even pathological conditions at all.

Another camp feels that it’s urgent for diseases to be defined and named, because it is a necessary step toward getting help for patients who need it. In this context, “help” mainly boils down to a decision as to whether the treatment will be covered by insurance. This is no small matter to either the patients or the professionals. It is also one area in which addicts, including food addicts, catch a bit of a break. A person suffering from schizophrenia absolutely needs professional care and medication, and somebody’s got to pay for it. An addict, on the other hand, can take advantage of the numerous organizations modeled after Alcoholics Anonymous, which are free and effective.

A currently insurmountable problem for everybody, however, is the lack of biomarkers for every diagnosis. A blood test for a physical ailment is definitive; the parallel tests in neuroscience are scarce, and the research is still in an exploratory stage. It may never be possible to delineate the “absolute threshold between normality and psychopathology.” Because the bottom line is, a certain amount of suffering is just life.

(To be continued…)

Your responses and feedback are welcome!

Source: “Inside the Battle to Define Mental Illness,” Wired, 12/27/10
Image by pasukaru76 (Pascal)l, used under its Creative Commons license.

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