Night eating syndrome, morning anorexia: how do we qualify an eating disorder and where do we draw the line?

Last week, I wrote about the rising new “rexias” in the eating disorder epidemic and based on the interest and comments on this topic, I have decided to dedicate today’s blog to an encore of the subject of eating disorder classification.  While this is the area of expertise in my counseling practice, it also is noted in a blog I was reading that the public has a “fascination” with eating disorders and the terrifying rate at which they are growing and mutating.  This blog brought up some interesting points as to which types of eating disorders should be classified in the DSM-V, the Diagnostic and Statistical Manual of Mental Disorders, the most recent edition of which is expected to be coming out in May 2013.  I say: why focus on the details?  If someone is exhibiting self harm in the form of eating disorders or other ways, this is a not-so-silent cry for help!

As I noted in my previous post, I wonder if the “rexias” such as pregorexia and drunkorexia are terms that are borne out of situational descriptions: a woman or man who is already dealing with an eating disorder or who is vulnerable to one finds himself using alcohol as an inhibitor to an eating disorder, or a woman becomes pregnant who has had disordered eating or body image problems for years.  To me, these are new mutations of anorexia or bulimia (or a combination of both), which are the two “classic” types of eating disorders in the DSM.  Binge Eating Disorder (BED) is a definite shoo-in for the DSM V, but counselors and practitioners in the field are wondering what other types of eating issues could make the cut…and I wonder how one decides what qualifies a “diagnostic” eating disorder — one clinical enough to make it in the mental health professional’s bible?

Blogs are talking about Night Eating Disorder (NES), which is qualified as a “disordered eating pattern in which an individual eats large quantities of food only at night.”  A study performed by Striegel-Moore and colleagues (2006) defined NES as “evening hyperphagia” (an abnormally increased appetite in the evening and consumption of food, after the evening meal, in which the majority of the day’s calories are consumed).  This may cause insomnia and “morning anorexia”.  This seems to me to be similar in criteria for Binge Eating Disorder, though NES appears only at night.  Binge Eating Disorder is defined as when someone frequently eats large quantities of food and feels a loss of control and an emotional response to their eating habits.  This does not involve the purging qualifier that bulimia nervosa does.  As mental health professionals, doctors, and psychologists meet to try to determine what types of behaviors make a disorder and what type of mental issues fall in line with which disorder, many questions come to surface — not only on the eating disorder front but across the mental health and physical health spectrum.  How do we decide what should be included in the newest version of the DSM so that proper diagnoses can be made and clients can be helped in the most efficient and adept way possible?  Is it better to have more probable diagnoses to look at when treating a client, or is less more?

As a counselor who treats individuals, couples, and families affected by eating disorders and as a woman who has dealt with emotional eating issues myself, I wonder if there is a trickle-down effect in handling the broadening scope of eating disorders.  As technology gets more advanced and as society grows larger and more complicated, the types of things that we can struggle with increase (alcohol, drugs, family pressures, wedding pressures, grief and loss, war casualties, and many more) as we cope with the overload of information we are given each day.  But underneath the surface, the river all runs to the same place or few places: the want to be accepted, loved, healed.  Maybe we eat uncontrollably at night because we cannot control our parents’ imminent divorce and the pain that causes.  Maybe we try to starve ourselves so that we fade away to nothing because the feeling of hunger is welcomed compared with the feeling of rejection from a group of peers.

I support incorporating as many words or classifications as possible in the DSM because the more attention we can bring to the dangerous epidemic of eating disorders, the more we can align into one solid voice advocating prevention and elimination.