I have been out of the full-time eating disorder world for awhile now, so issues that are daily topics of debate for some colleagues aren't on my radar as frequently. One that just came to my attention is that the proposed diagnostic criteria for eating disorders for the new Diagnostic and Statistical Manual, version V, may not work in the favor of women with PCOS.
For those of you not familiar with this manual, it is a handbook written by the American Psychiatric Association containing diagnostic criteria for diagnoses ranging from schizophrenia to learning disabilities. Eating disorders are all included, and treatment teams at eating disorder centers use this manual daily as a way to diagnose and categorize treatment plans for their patients.
Here is the main link with further links to all three proposed eating disorder diagnostic criteria: anorexia nervosa, bulimia nervosa, and binge eating disorder.
The nice change that I am happy to see, is that binge eating disorder is actually a proposed official diagnosis. It has been very hard for men and women with this diagnosis to be taken seriously when asking for help. This step on the part of the APA is a much-needed advancement in eating disorders treatment.
What I'm very troubled by, is that there is no recognition, whatsoever, in any of these three diagnoses, of the hormonal changes that are an important part of the diagnosis and treatment of them.
--Loss of menses in anorexia nervosa, part of the diagnostic criteria in DSM-IV, has been removed from the proposed DSM-V version.
--Changes in menstrual health, though well-documented to exist in bulimia, are not noted as a diagnostic criteria.
--No mention of menstrual function exists in the new proposed criteria for binge eating disorder.
My personal belief is that one of the most crucial points of identification for PCOS…is eating disorder treatment. When a woman recognizes that her hunger and appetite mechanisms are not working, and she asks for help with this problem from eating experts, it seems to me that one of the very first things this team should be evaluating, is whether or not the problem has a physical/metabolic origin. If you try and treat a metabolic issue primarily as if it is a psychiatric and/or behavioral issue, you're likely going to have a lot of trouble succeeding in the treatment of that problem.
I'm not the only person who feels that way. A dietitian who completed the inCYST training and who worked in an eating disorder treatment center screened the population of that center for the potential presence of PCOS. The findings were so profound that she shared with me once that she believes screening for the presence of PCOS, by anyone working in eating disorders, should be a universal precaution.
I'm optimistic that some of the research I hope to fund with our up and coming nonprofit foundation will change the way eating disorder treatment professionals currently think. To not include neuroendocrine disruption in the diagnostic criteria, is a huge oversight and it keeps the professionals working in eating disorder treatment from improving their reported rates of treatment success from being higher than they currently are.
And that by the time I am hopefully long retired and working on my screenplay that has nothing to do with PCOS, the diagnostic criteria for the DSM-VI, for all three eating disorders, will certainly include menstrual irregularities.