The absent body in psychiatric diagnosis, treatment, and research
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Discussions of psychiatric nosology focus on a few popular examples of disorders, and on the validity of diagnostic criteria. Looking at Anorexia Nervosa, an example rarely mentioned in this literature, reveals a new problem: the DSM has a strict taxonomic structure, which assumes that disorders can only be located on one branch. This taxonomic assumption fails to fit the domain of psychopathology, resulting in obfuscation of cross-category connections. Poor outcomes for treatment of Anorexia may be due to it being pigeonholed as an Eating Disorder, when a disturbance of body perception may be a more central symptom than food restriction. This paper explores the possibility of restructuring the DSM taxonomy to allow for a pluralist classification of disorders. This change could improve treatment and research without requiring any changes to diagnostic criteria.
KeywordsPsychiatric nosology DSM Anorexia nervosa Body perception Taxonomy RDoC
This research was supported in part by Deutsche Forschungsgemeinschaft Excellence Cluster Grant CIN2011-16, at the Centre for Integrative Neuroscience, Universität Tübingen. Many thanks to the anonymous reviewers whose suggestions greatly improved the paper. I acknowledge the Ancestral Traditional Territories of the Ojibway, the Anishnabe, and the Mississaugas of the New Credit, where I live and work, and I am grateful to the people living with Anorexia Nervosa whose stories inspired this paper.
- American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders, Text Revision (4th ed.). Arlington: APA.Google Scholar
- American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington: APA.Google Scholar
- Bartky, S. L. (2002). Suffering to be beautiful. “Sympathy and Solidarity” and other essays (pp. 13–30). Lanham, MD: Rowman & Littlefield.Google Scholar
- Castellini, G., Sauro, C. L., Mannucci, E., Ravaldi, C., Rotella, C. M., Faravelli, C., et al. (2011). Diagnostic crossover and outcome predictors in eating disorders according to DSM-IV and DSM-V proposed criteria: A 6-year follow-up study. Psychosomatic Medicine, 73(3), 270–279.CrossRefGoogle Scholar
- Catalan-Matamoros, D., Helvik-Skjaerven, L., Labajos-Manzanares, M. T., Martínez-de Salazar-Arboleas, A., & Sánchez-Guerrero, E. (2011). A pilot study on the effect of Basic Body Awareness Therapy in patients with eating disorders: A randomized controlled trial. Clinical Rehabilitation, 25(7), 617–626.CrossRefGoogle Scholar
- Clausen, L., Rosenvinge, J. H., Friborg, O., & Rokkedal, K. (2011). Validating the Eating Disorder Inventory-3 (EDI-3): A comparison between 561 female eating disorders patients and 878 females from the general population. Journal of Psychopathology and Behavioral Assessment, 33(1), 101–110.CrossRefGoogle Scholar
- First, M. B. (2010). Paradigm shifts and the development of the Diagnostic and Statistical Manual of Mental Disorders: Past experiences and future aspirations. The Canadian Journal of Psychiatry, 55(11), 692–700.Google Scholar
- Kaye, W. H., Wagner, A., Fudge, J. L., & Paulus, M. (2010). Neurocircuity of eating disorders. In R. A. H. Adan & W. H. Kaye (Eds.), Behavioral Neurobiology of Eating Disorders, Current topics in behavioral neurosciences (Vol. 6, pp. 37–58). Berlin, Heidelberg: Springer.Google Scholar
- Kendler, K. S., & Parnas, J. (Eds.). (2012). Philosophical issues in psychiatry II: Nosology. Oxford: Oxford University Press.Google Scholar
- Knapp, C. (2010). Appetites: Why women want. New York: Counterpoint.Google Scholar
- Kupfer, D. J., First, M. B., & Regier, D. A. (2002). A research agenda for DSM V. Arlington: American Psychiatric Publishing.Google Scholar
- National Institute of Mental Health. (1993). Prevalence: Schizophrenia. http://www.nimh.nih.gov/health/statistics/prevalence/schizophrenia.shtml.
- National Institute of Mental Health. (2007). Eating disorders among adults—anorexia nervosa. http://www.nimh.nih.gov/health/statistics/prevalence/eating-disorders-among-adults-anorexia-nervosa.shtml.
- Pike, K. M., Walsh, B. T., Vitousek, K., Wilson, G. T., & Bauer, J. (2003). Cognitive behavior therapy in the posthospitalization treatment of anorexia nervosa. American Journal of Psychiatry, 160(11), 2046–2049.Google Scholar
- Poland, J. (2014). Deeply rooted sources of error and bias in psychiatric classification. In H. Kinkaid & J. Sullivan (Eds.), Classifying psychopathology: Mental Kinds and natural kinds (pp. 29–63). Cambridge: MIT Press.Google Scholar
- Psych Guides. (2016). Using Aetna for eating disorder treatment. http://www.psychguides.com/guides/using-Aetna-for-eating-disorder-treatment/.
- Strigo, I. A., Matthews, S. C., Simmons, A. N., Oberndorfer, T., Klabunde, M., Reinhardt, L. E., et al. (2013). Altered insula activation during pain anticipation in individuals recovered from anorexia nervosa: Evidence of interoceptive dysregulation. International Journal of Eating Disorders, 46(1), 23–33.CrossRefGoogle Scholar
- Sullivan, J. A. (2016). Stabilizing constructs through collaboration across different research fields as a way to foster the integrative approach of the research domain criteria (RDoC) project. Frontiers in Human Neuroscience, 10, 309. doi: 10.3389/fnhum.2016.00309.
- Tabb, K., & Schaffner, K. F. (2017). Causal pathways, random walks and tortuous paths: Moving from the descriptive to the etiological in psychiatry. In Kendler, K. S., Parnas, J. (eds.) Philosophical issues in psychiatry IV: Psychiatric Nosology (pp. 342–360), Oxford University Press.Google Scholar
- Yager, J., Devlin, M. J., Halmi, K. A., Herzog, D. B., Mitchell, J. E., Powers, P., et al. (2006). Practice guideline for the treatment of patients with eating disorders (3rd ed.). Arlington: American Psychiatric Association.Google Scholar
- Yager, J., Devlin, M. J., Halmi, K. A., Herzog, D. B., Mitchell, J. E., Powers, P., et al. (2014). Guideline watch (August 2012): Practice guideline for the treatment of patients with eating disorders, 3rd edn. FOCUS, 12(4), 416–431.Google Scholar
- Zachar, P. (2008). Real kinds but no true taxonomy: An essay in psychiatric systematics. In K. S. Kendler & J. Parnas (Eds.), Philosophical issues in psychiatry: Explanation, phenomenology, and nosology. Baltimore: Johns Hopkins University Press.Google Scholar