An Investigation of the Clinical Utility of the Proposed ICD-11 and DSM-5 Diagnostic Schemes for Eating Disorders Characterized by Recurrent Binge Eating in People with a High BMI

Abstract

The aims of this paper were to compare (1) the proportion of participants diagnosed with threshold or subthreshold Bulimia Nervosa (BN) and Binge Eating Disorder (BED) (clinical utility), and (2) the severity of participants’ clinical features and mental Health-Related Quality of Life (HRQoL) (convergent validity), when diagnosed according to either the Diagnostic and Statistical Manual of Mental Disorders—5th edition (DSM-5) or the proposed International Classification of Diseases 11th edition (ICD-11) schemes. One hundred and seven adult men and women, with a high Body Mass Index (BMI) were evaluated by interview to confirm their eating disorder diagnoses. All participants completed self-report assessments of current symptoms and mental HRQoL. The majority of participants in either diagnostic scheme were included in the main categories of BN or BED (102/107, 95% in the ICD-11 and 85/107, 79% in the DSM-5). Fewer individuals received a subthreshold other or unspecified diagnosis with the ICD-11 compared to the DSM-5 scheme (5% vs. 21%). No significant differences in demographic, clinical features or mental HRQoL of participants with complete or partial BN or BED were found between diagnostic categories. Compared to the DSM-5, the proposed ICD-11 was not over inclusive, i.e., it did not appear to include people with less severe and potentially less clinically relevant symptoms. These results support the greater clinical utility of the ICD-11 whilst both schemes showed convergent validity.

Comparative utility of the DSM‐5 and ICD‐11 diagnostic classifications of eating disorders of recurrent binge eating in an Australian community‐based sample

“…However, the prevalence of BN was the same and of OSFED-BN/BED were closely similar. This contrasts with Palavras et al (2018) who found in a clinical propulsion 14% of individuals to be diagnosed with DSM-5 BN versus 18.7% diagnosed with ICD-11 BN and 65.4% of individuals diagnosed with DSM-5 BED versus 76.6% diagnosed with ICD-11 BED. Thus, the broader criteria proposed in the ICD-11 increases the number of people with BED to a greater degree than in the DSM-5 and this was more marked in this community population.…”

Eating Disorders and Obesity: The Challenge for Our Times

“…The validated EBQ can now be used in research investigations; for example, the role of potentially remedial beliefs and behaviors as indicators of obesity and eating disorder risk. Amorim Palavaras et al [18] found that the broader definition of binge eating (with emphasis on loss of control over eating rather than quantity consumed) in the ICD-11 proved of greater utility without loss of validity in a clinical population of individuals with high BMI.…”

Current approaches in the recognition and management of eating disorders

“…binge eating disorder, allowing for the occurrence of subjective binge eating episodes, thus potentially increasing the clinical utility of the ICD-11 compared with the DSM-5-TR for binge eating disorder. 33,34 ARFID is characterised by the avoidance of and aversion to food and eating. 1,2 Notably, this restriction is not the result of a body image disturbance but is due to anxiety or a heightened sensitivity to the sensory aspects of food.…”

“…The DSM‐5‐TR and ICD‐11 differ in their criteria for binge eating disorder, with the DSM‐5‐TR requiring three additional descriptors 1,2 . The broader ICD‐11 criteria appear more congruent with lived experience reports of binge eating disorder, allowing for the occurrence of subjective binge eating episodes, thus potentially increasing the clinical utility of the ICD‐11 compared with the DSM‐5‐TR for binge eating disorder 33,34 …”