Alternative methods of classifying eating disorders: Models incorporating comorbid psychopathology and associated features

Abstract

There is increasing recognition of the limitations of current approaches to psychiatric classification. Nowhere is this more apparent than in the eating disorders (EDs). Several alternative methods of classifying EDs have been proposed, which can be divided into two major groups: 1) those that have classified individuals on the basis of disordered eating symptoms; and, 2) those that have classified individuals on the basis of comorbid psychopathology and associated features. Several reviews have addressed symptom-based approaches to ED classification, but we are aware of no paper that has critically examined comorbidity-based systems. Thus, in this paper, we review models of classifying EDs that incorporate information about comorbid psychopathology and associated features. Early approaches are described first, followed by more recent scholarly contributions to comorbidity-based ED classification. Importantly, several areas of overlap among the classification schemes are identified that may have implications for future research. In particular, we note similarities between early models and newer studies in the salience of impulsivity, compulsivity, distress, and inhibition versus risk taking. Finally, we close with directions for future work, with an emphasis on neurobiologically-informed research to elucidate basic behavioral and neuropsychological correlates of comorbidity-based ED classes, as well as implications for treatment.

incorporating dimensions into the classification of eating disorders: Three models and their implications for research and clinical practice

“…For a more complete overview of comorbidity and the classification of EDs, the interested reader is referred to Ref. (22). …”

Empirically Derived Subtypes of Full and Subthreshold Anorexia Nervosa in Adolescent Females: Understanding General Psychopathology and Treatment Implications

“…Cluster analysis has typically been used to examine alternative models to the predominant Diagnostic and Statistical Manual of Mental Disorders ED classifications (DSM; American Psychiatric Association [APA], 2013). Wildes and Marcus (2013) have discussed how these alternative models to the DSM ED classifications can be separated into two groups. On the one hand, researchers have clustered individuals based on ED symptomatology.…”

Personality assessment inventory profiles of university students with eating disorders

“…This suggests that future studies may want to consider the presence of other forms of psychopathology in addition to the diagnosis of an eating disorder when studying this population. For example, comparing those with an eating disorder and borderline personality disorder (BPD) separately from those without BPD, and those with obsessive compulsive disorder separately from those without the comorbid diagnosis [30,[71][72][73][74]. It may be that eating disorder symptoms present differently when there are comorbid diagnoses and this is why there have been inconsistent results relating psychopathology to eating disorders.…”

“…Many studies have attempted to differentiate among eating disorder subtypes on the basis of psychopathology [27][28][29][30]. These investigations have sought: 1) to determine the utility of personality and psychopathology measures as diagnostic and/or classification instruments, 2) to evaluate the psychometrics of these tests when generalized to different populations, and 3) to elucidate the personality and psychopathology differences among eating disorder subtypes.…”

“…This latter point is particularly important as different eating disorders share some similar diagnostic features (e.g., concern about weight). Wildes and Marcus argue in favour of considering psychopathology and other associated features when classifying eating disorders and using the information when making diagnosis [30]. Personality and psychopathology instruments such as the PAI are often routinely administered at intake to all patients seeking treatment [31].…”