My Submission on the Proposed Changes to the DSM and Eating Disorder Diagnoses
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the primary classification system used by mental health professionals around the world to diagnose mental health conditions. It shapes how clinicians assess and understand distress, how services determine eligibility for care, how research is conducted and, in many cases, how funding and insurance decisions are made. In short: what appears in the DSM and how it is described has very real consequences for people’s lives.
The DSM is not static. It is periodically reviewed and updated as scientific evidence evolves and as clinicians and researchers identify areas where diagnostic criteria no longer reflect real-world presentations. At times, the American Psychiatric Association invites public and professional feedback on proposed changes. Recently, the Committee sought feedback on proposed corrections to the severity specifiers for eating disorders, including Anorexia Nervosa, Bulimia Nervosa, and Binge-Eating Disorder.
Severity specifiers may sound technical, but they matter deeply. They influence how seriously an illness is taken, how risk is assessed, and whether someone is deemed “unwell enough” to access appropriate treatment. Historically, eating disorder severity has been too closely tied to weight or body size or to frequency of behaviours; an approach that does not reliably reflect medical risk, psychological distress, or functional impairment. This has contributed to delayed diagnoses, invalidating experiences, and barriers to care for many individuals.
The submission below outlines my support for the proposed DSM changes and raises several areas I believe warrant ongoing consideration. I am sharing my submission publicly in the hope of increasing transparency, promoting informed discussion, and highlighting why diagnostic systems - whilst often perceived as abstract or bureaucratic - are profoundly relevant to anyone affected by eating disorders, whether personally, professionally, or as a caregiver.
My Submission to the DSM Committee
I am writing in my capacity as a Clinical Psychologist who has specialised in the assessment and treatment of eating disorders for the past 12 years. My experience spans both public and private sectors and includes work across outpatient, day programme, and residential treatment settings. I welcome the opportunity to comment on the proposed corrections to the severity specifiers for Anorexia Nervosa, Bulimia Nervosa, and Binge-Eating Disorder, and I wish to express my strong support for these proposed changes.
From a clinical perspective, the proposed revisions represent a meaningful step toward greater diagnostic accuracy and clinical utility. In particular, moving away from overly narrow or weight-centric markers of severity aligns more closely with contemporary research and with the realities encountered in clinical practice. Severity in eating disorders is far more accurately reflected by factors such as psychological distress, functional impairment, medical instability, chronicity, and risk, rather than by weight or body size alone. The proposed changes better support this more holistic and clinically valid understanding of illness severity, and they are likely to reduce misclassification, under-recognition of risk, and barriers to care.
I would also like to draw the Committee’s attention to the increasing prevalence of presentations that would traditionally be described as “Atypical Anorexia Nervosa.” I am encountering a growing number of individuals who meet all core psychological and behavioural criteria for Anorexia Nervosa and who experience significant medical compromise, distress, and functional impairment, yet who do not fall below a low-weight threshold. In practice, these presentations are often as severe and at times more medically precarious than cases of “typical” Anorexia Nervosa.
While the inclusion of Atypical Anorexia Nervosa under OSFED has been an important step in recognising these presentations, I would encourage the Committee to consider whether this condition warrants recognition as its own diagnostic entity, rather than remaining within a residual or “catch-all” category. Additionally, the term “atypical” can be experienced by patients as invalidating or minimising, despite the seriousness of their illness. Consideration of alternative nomenclature that more accurately reflects the severity and legitimacy of this condition may help reduce stigma, improve patient engagement, and support equitable access to treatment.
I also wish to encourage the Committee to continue monitoring and engaging with the growing body of research into emerging and evolving eating disorder presentations. In particular, ongoing research into orthorexia, diabulimia, and post-surgical eating avoidance disorders will be important in determining whether and how these presentations may be best conceptualised diagnostically in future DSM revisions. Additionally, as the use of GLP-1 receptor agonists becomes increasingly widespread, I believe it will be critical for the Committee to remain attentive to emerging evidence regarding eating disorder onset, relapse, or exacerbation associated with these medications, particularly among vulnerable populations.
In summary, I strongly support the proposed corrections to the severity specifiers for eating disorders and commend the Committee for taking steps that better reflect contemporary clinical understanding and research evidence. I appreciate the opportunity to provide feedback and would welcome continued evolution of the DSM in ways that improve diagnostic validity, reduce stigma, and ultimately enhance care for individuals affected by eating disorders.
Respectfully submitted,
Dr. Eve Hermansson-Webb, Clinical Psychologist
Eating Disorder Specialist