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Tuesday, May 25, 2010

Eating Disorders, DSM5 at the APA

One always has a dilemma at the APA Annual meeting, and I call this the embarrassment of riches problem: there is so much going on that it is hard to choose what to attend. I try to attend a few talks outside my main interests so that I can keep up in other areas. But so much is going on, how does one choose? Sometimes I’ll choose to listen to a well-known expert, and other times I’ll choose a workshop or symposium based on a provocative title. Not infrequently, I will conclude that I made the wrong choice, and will leave and seek out something else. And sometimes I will enter a room almost at random because I want to rest.
I had reviewed the agenda and decided to listen to Kathy Halmi talk about eating disorders. She actually trained at my program (Iowa), and while she left before I got there, we have interacted a number of times, and I highly respect her. She has a no-nonsense way of thinking and presenting material that I like, and I guess what I learned was that--according to her--a core problem of anorexic patients is their sense of ineffectiveness. I guess I had never thought of that before. She provided a review of treatments, and all I can say is that more work is desperately needed.

That afternoon, I sat in on a DSM5 update and listened to Joel Dimsdale talk about proposed changes to the somatoform disorders. Now I have a beef about this: somatization disorder is probably one of the best validated disorders, though is underutilized. The diagnosis stems from Briquet’s syndrome, and was defined and validated by the Washington University group in the 1950’s. I ask: why are we even thinking about removing a valid diagnosis from the manual just because it is underutilized? I then sat in on a friend’s talk (Pinhas Dannon) about the neuropsychology of pathological gambling. He contends that these patients are not impulsive, and hence that pathological gambling is a behavioral addiction. The problem I have with this is that I think they are impulsive, and that’s what I see in my samples. (This is a research interest of mine – yes, we have loads of gambling in Iowa).

Donald W. Black, MD
University of Iowa

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