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

Abstract

Objective Given renewed interest in dimensional approaches in psychiatric nosology, we review evidence for the utility of including dimensions of eating disorder (ED) psychopathology, comorbid psychopathology, and neurobiology in the classification of EDs. Method We searched on-line databases and reference lists of published papers for articles on dimensional methods in psychiatric classification, with an emphasis on EDs. Results ED classification may be enhanced by including dimensional assessments. Specifically, some ED features appear to exist on a continuum with normality, and dimensional measures of ED severity are likely to have utility in clinical contexts. Furthermore, accumulating data support the validity of ED classification schemes that incorporate dimensions of comorbid psychopathology. Finally, neurobiological dimensions have gained increasing notice across the psychiatric literature and may be particularly salient to the classification of EDs. Discussion An approach to ED classification that incorporates multiple dimensional measures may have the greatest utility for advancing ED treatment.

Extracting body image symptom dimensions among eating disorder patients: The Profile Analysis via Multidimensional Scaling (PAMS) approach

“…This is strong evidence that the PAMS (core) response patterns work properly to encapsulate all individuals' response profiles. This relatively unique characteristic of PAMS may be particularly relevant for eating disorder research given more recent notions that an approach to classification that incorporates multiple dimensions hasthe greatest utility for advancing research in eating disorders (Wildes & Marcus, 2013). Moreover, the core response patterns identified in the present study appear to be consistent with prior eating disorder research that is dimensionally oriented.…”

“…A focus on dimensional aspects of eating disorders is timely given the recent emphasis on dimensions in DSM-5 (Helzer et al, 2008;Wildes & Marcus, 2013), the Research Domain Criteria (RDoC) initiative advocated by the National Institute of Mental Health, and recent interest in dimensional approaches within the eating disorder field (Wildes & Marcus, 2013). Accordingly, the present study employed PAMS, a procedure for uncovering dimensions, to highlight core eating disorder symptoms among a large sample of patients with eating disorders.…”

The dimensional nature of eating pathology: Evidence from a direct comparison of categorical, dimensional, and hybrid models.

“…For example, Wilde and Marcus (2013) summarized evidence for three proposed dimensional approaches, including one approach to model key dimensions of eating pathology, one approach to model dimensions of comorbid psychopathology, and one approach to model neurological dimensions (e.g., the impulsivity and compulsivity dimensions) (Wildes & Marcus, 2013). Our findings underscore the need for future studies to continue exploring the best dimensional classification systems for eating pathology.…”

“…Although some studies have demonstrated concurrent and predictive validity for the existing categorical eating disorder diagnoses (Keel, Brown, Holland, & Bodell, 2012), whether a dimensional conceptualization can capture the nature of eating disorders better than categorical approaches has not been extensively evaluated (Wildes & Marcus, 2013; Wilfley, Bishop, Wilson, & Agras, 2007; Wonderlich, Joiner, Keel, Williamson, & Crosby, 2007). There is a high percentage of eating disorder cases that cannot be categorized within the current DSM system (i.e., other specified feeding and eating disorders [OSFEDs] in DSM-5, or Eating Disorder Not Otherwise Specified [EDNOS] in DSM-IV-R; (APA, 2000) Fairweather-Schmidt & Wade, 2014; Machado, Machado, Gonçalves, & Hoek, 2007) and high rates of cross-over exist between categorical eating disorder diagnoses (e.g., between anorexia nervosa [AN] and bulimia nervosa [BN]; Eddy et al, 2008).…”

Empirically derived personality subtyping for predicting clinical symptoms and treatment response in bulimia nervosa

“…Evidence supports the use of personality subtyping for identifying meaningful phenotypes among individuals with eating disorders, including bulimia nervosa (BN). This approach has been used with various eating disorder populations, and three personality subtypes have consistently emerged: (a) an under‐controlled subtype, characterized by behavioral and emotional dysregulation; (b) an over‐controlled subtype, characterized by inhibition and compulsivity; and (c) a low psychopathology subtype, characterized by relatively normative scores on selected personality indicators. These personality subtypes have been shown to reliably differentiate individuals with eating disorders in clinical presentation and initial evidence indicates they also predict treatment response …”