The world has a lot to say about binge eating. Sometimes the search for a more precise definition leads off into fascinating side roads.
In its 5th edition, the Diagnostic and Statistical Manual of Mental Disorders decided to file BED, or Binge Eating Disorder, under OSFED, or “Other Specified Feeding or Eating Disorder.” Additionally, BED itself has been broken down into “low frequency and/or limited duration” and “higher frequency and duration;” and then it might be further categorized as mild, moderate, or severe.
Within those parameters, it is still important to understand that not all obese people suffer from BED, nor are all people with BED obese. But they do mostly tend to be moody and anxious.
Classification problems have haunted the field for a long time — not just in the realm of eating disorders, but in everything connected with mental health. To get a grip on this topic, it is apparently necessary to keep track of a lot of initials. For instance, the cluster of letters DSM-ICD. Spelled out, that stands for “Diagnostic and Statistical Manual of Mental Disorders and International Classification of Diseases.”
A 2016 paper explicated the basis of that school of thought, classified as “an Aristotelian view.” From this angle, mental disorders are seen as “largely discrete entities that are characterized by distinctive signs, symptoms, and natural histories.”
And, as far back as 1989, there had been mumbles and grumbles, an example of which came from psychiatrist R. E. Kendell:
One important possibility is that the discrete clusters of psychiatric symptoms we are trying to delineate do not actually exist.
Then, along came a contrary modality, in fact, a paradigm shift, described as “a Galilean view of psychopathology as the product of dysfunctions in neural circuitry.” This is the RDoC (Research Domain Criteria) initiative, which strives to make sense of what were called the “accumulating anomalies” that troubled professionals when contemplating the older system. Many factors contributed to the restlessness that inspired leaders in the field to call for change.
Remedies made to order
For instance, the authors cited “precision medicine” or “personalized medicine” which translates lab results directly into an individually tailored plan of action. As an example, they mentioned a targeted drug treatment that works for 4% of cystic fibrosis patients, and went on to describe another advance that has “stirred hopes for a similar revolution in psychiatry and clinical psychology.”
Also in the conversation is Oncotype testing, which has revolutionized the treatment of breast cancer by “permitting physicians to move from a ‘one size fits all’ intervention approach to treatment geared to specific genetic profiles.”
They go on to explain the analogy to the Research Domain Criteria:
Rather than base psychiatric diagnosis on presenting signs and symptoms […] RDoC strives to anchor psychiatric classification and diagnosis in a scientifically supported model of neural circuitry. RDoC conceptualizes mental disorders as dysfunctions in brain systems that bear important adaptive implications, such as systems linked to reward responsiveness and threat sensitivity.
Of course, this fundamental declaration branches out into several “crucial assumptions,” some of which are explained in detail. Other experts added depth and breadth to the many dimensions of this expanded worldview.
One was neuroscientist and psychiatrist Thomas R. Insel, who was for more than a decade in charge of the National Institute of Mental Health. Even though in most areas of medicine the public has come to expect a high degree of specificity, he warned, we might as well not anticipate anything of the sort in the field of psychiatric diagnostics.
Because behavioral symptoms are multidetermined (our old friend “multifactorial“), he wrote, “[…] diagnoses based only on presenting complaints are unavoidably heterogeneous in terms of pathophysiology.” Along with this unavoidable truth comes a danger:
[W]hen diagnosis is limited to symptoms, treatments may be limited to symptom relief, precluding cures or preventive interventions.
Your responses and feedback are welcome!
Source: “Clashing Diagnostic Approaches: DSM-ICD versus RDoC,” NIH.gov, 02/03/16
Source: “The NIMH Research Domain Criteria (RDoC) Project: Precision Medicine for Psychiatry,” PsychiatryOnline.org, 04/01/14
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