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The absent body in psychiatric diagnosis, treatment, and research

  • S.I. : Psych&Phil
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Abstract

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.

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Notes

  1. Online communities that provide pro-anorexia/bulimia safe spaces where people who severely restrict their diets share their experiences and offer support.

  2. The 2013 exchange rate of US$1 = Can$1.03 is given in the text.

  3. Based on the average exchange rate for 2004.

  4. Based on the average exchange rate for 2002.

  5. The 2012 update to the APA Practice Guideline claims that the document remains “substantially correct and current in its recommendations” (Yager et al. 2014).

  6. The concept of body image may not exactly match the DSM description for Criterion C, but I’ll set aside that worry.

  7. Given AN’s complex etiology, all three approaches may prove helpful.

  8. Interoceptive awareness (IA) and ID are conceptualized as measuring opposite directions of the same construct, and while highly correlated, are measured using very different protocols (heartbeat detection versus questionnaire), so should be considered two distinct clinical indicators. For simplicity, I’ll use them as antonyms here.

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Acknowledgements

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.

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    Catherine Stinson

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Stinson, C. The absent body in psychiatric diagnosis, treatment, and research. Synthese 196, 2153–2176 (2019). https://doi.org/10.1007/s11229-017-1507-8

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