The major impetus for this book was the publication in the spring of 2013 of DSM-5 (American Psychiatric Association 2013). DSM-5 introduced both major and minor changes to the conceptualization of, and to the diagnostic criteria for, feeding and eating disorders. We felt it would be timely to review these changes and to embed them in a broader, up-to-date description of the assessment and treatment of individuals with eating disorders. In addition, in this new diagnostic era, there have been important developments in the technologies available to aid diagnosis, research, and treatment. Thus, this volume aims throughout the text to engage the reader (and the field in general) in thoughtful consideration of when, how, and why technology might be used to improve assessment and treatment.
The opening chapter in Part I (“Introduction”) describes the evolution of the DSM-5 section on feeding and eating disorders. The rationale for making diagnoses is reviewed, including both advantages and disadvantages of the DSM approach. The specific alterations in the diagnostic criteria for each disorder are described, and guidance is provided for clinicians regarding how to apply criteria in practice. Two major changes in DSM-5 are highlighted, the official recognition of binge-eating disorder and the formulation of the newly named avoidant/restrictive food intake disorder.
Following Chapter 1, content is organized in three parts. Part II, “Evaluation and Diagnosis of Eating Problems,” comprising six chapters, provides guidance for clinicians on the evaluation of individuals who have symptoms suggesting a possible eating disorder. The approaches to adults and to children and adolescents are described in Chapters 2 and 3; these chapters highlight the fundamental principles and practices necessary for careful assessments of individuals with eating disorders. Chapters 4-6 are guides to the assessment of individuals with more specialized problems, including overweight individuals, those considering bariatric surgery, and men and boys. Part II concludes with a description of the impact of culture on the manifestation and assessment of eating problems (Chapter 7).
Part III, “Assessment Tools,” describes tools available to clinicians to assist in the assessment of eating disorders. The initial chapter of this section, Chapter 8, provides a critical review of the first assessment methods developed to assess eating disorders and the recent evolution of new instruments. Chapter 9 describes self-report measures; given the time pressures on modern clinical practice, such measures serve to enhance both the accuracy and the efficiency of patient care. Chapter 10 outlines how to use the Eating Disorder Assessment for DSM-5 (EDA-5), a semistructured interview developed by the group from the Columbia Center for Eating Disorders to rigorously but quickly determine whether DSM-5 criteria for a feeding or eating disorder are satisfied; this interview is available at www.eda5.org. Chapter 11 details methods to aid the assessment of children and adolescents, and Chapter 12 reviews the cutting edge of eating disorder assessments, namely, the use of handheld devices such as smart-phones.
Part IV of the volume, “Treatment,” consisting of three chapters, provides an overview of treatment. Chapter 13 focuses on restrictive eating disorders, such as anorexia nervosa and avoidant/restrictive feeding intake disorder. Chapter 14 reviews the treatment of binge eating, as seen in bulimia nervosa and binge-eating disorder. Chapter 15 addresses less commonly seen problems such as pica and rumination.
In association with the text, the authors have produced several short videos to highlight methods of patient assessment and diagnosis. The reader will find references to these videos in relevant chapters of the book. The videos may be accessed at www.appi.org/Walsh.
A critical part of our field’s progress is an appreciation for all types of clinical expertise at all levels of experience. We ourselves represent different eras, and while each of us arrived at this project with a unique perspective on the past and present state of the assessment and treatment of eating disorders, our shared investment is certainly in its future. We greatly appreciate the equally diverse group of esteemed colleagues who have collaborated with us on this project. Among our authors are adult and child psychiatrists, psychologists, pediatricians, nutritionists, and postdoctoral fellows. Some of us have been devoted to this field for decades, while others have joined more recently with the hope of carrying the work forward for decades to come.
And we would be remiss not to mention Christine Call, A.B., our research assistant, without whom this project would not have gotten off the ground and certainly would never have landed safely!
Finally, we would especially like to thank our patients, from whom we continue to learn, for their courage in sharing their symptoms and struggles and for the privilege of allowing us to collaborate on their path to recovery.
We hope that whether you come to this text as a student or a seasoned professional, as a general practitioner or an eating disorders specialist, as a researcher or a clinician, our book will help to answer some of your questions and inspire new ones.
B. Timothy Walsh, M.D.
Evelyn Attia, M.D.
Deborah R. Glasofer, Ph.D.
Robyn Sysko, Ph.D.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. Arlington, VA, American Psychiatric Association, 2013