Personality pathology in purging disorder and bulimia nervosa

Brown, Tiffany A.; Haedt‐Matt, Alissa A.; Keel, Pamela K.

doi:10.1002/eat.20904

Cited by 32 publications

(34 citation statements)

References 22 publications

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“…Also, PD did not differ from any other diagnosis concerning change in psychopathology or remission rates from start to follow-up, which supports studies finding no differences in treatment outcome between PD, AN and BN [20,21]. SBE has been suggested to be of special importance in defining PD [47], but in the present sample it was common in several diagnoses and not distinctive for PD. Taken together, the present results suggest no grounds for considering PD as a distinct ED.…”

Section: Discussionsupporting

confidence: 81%

Clinical characteristics and distinctiveness of DSM-5 eating disorder diagnoses: findings from a large naturalistic clinical database

et al. 2013

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BackgroundDSM-IV eating disorder (ED) diagnoses have been criticized for lack of clinical utility, diagnostic instability, and over-inclusiveness of the residual category “ED not otherwise specified” (EDNOS). Revisions made in DSM-5 attempt to generate a more scientifically valid and clinically relevant system of ED classification. The aim with the present study was to examine clinical characteristics and distinctiveness of the new DSM-5 ED diagnoses, especially concerning purging disorder (PD). MethodsUsing a large naturalistic Swedish ED database, 2233 adult women were diagnosed using DSM-5. Initial and 1-year follow-up psychopathology data were analyzed. Measures included the Eating Disorder Examination Questionnaire, Structural Eating Disorder Interview, Clinical Impairment Assessment, Structural Analysis of Social Behavior, Comprehensive Psychiatric Rating Scale, and Structured Clinical Interview for DSM-IV Axis I Disorders.ResultsFew meaningful differences emerged between anorexia nervosa binge/purge subtype (ANB/P), PD, and bulimia nervosa (BN). Unspecified Feeding and Eating Disorders (UFED) showed significantly less severity compared to other groups.ConclusionsPD does not appear to constitute a distinct diagnosis, the distinction between atypical AN and PD requires clarification, and minimum inclusion criteria for UFED are needed. Further sub-classification is unlikely to improve clinical utility. Instead, better delineation of commonalities is important.

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Section: Discussionsupporting

confidence: 81%

Clinical characteristics and distinctiveness of DSM-5 eating disorder diagnoses: findings from a large naturalistic clinical database

et al. 2013

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“…For example, despite a focus on PD for one of the studies included in analyses, 18 a latent PD group did not emerge. Instead, most cases of PD fell within LC1 along with cases of AN binge-purge subtype, BN purging and nonpurging subtypes, and BED that came from several studies contributing to analyses.…”

Section: Discussionmentioning

confidence: 99%

“…11, 17, 18 Importantly, the largest of these studies 11 contributed 192 (36%) participants and allowed for full variation of possible eating disorder symptoms ranging from DSM-IV AN binge-purge subtype to individuals free from eating disorder symptoms to permit evaluation of a dimensional model. Participants were between the ages of 18 and 53 years; mean (SD) age was 26.2 (7.3) years.…”

Section: Methodsmentioning

confidence: 99%

Evaluating new severity dimensions in the DSM‐5 for bulimic syndromes using mixture modeling

Keel¹,

Crosby²,

Hildebrandt³

et al. 2012

Intl J Eating Disorders

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Objective Proposed DSM-5 severity dimensions reveal ambiguity regarding the extent to which certain features define boundaries between similar diagnoses or represent underlying dimensions within a broader category of bulimic syndromes. The current study utilized a novel mixed modeling approach that can simultaneously model latent dimensions and latent categories to address this ambiguity. Method Data from structured clinical interviews in 528 adult participants were analyzed. Results A 3-class solution with one severity dimension that was invariant across groups provided the best-fitting model. Both latent classes 1 and 2 included bulimic syndromes but were distinguished by greater purging and weight phobia in latent class 1. Latent class 3 resembled a non-eating disorder class. External validation analyses supported significant differences among empirically derived groups. Discussion Weight phobia contributes to categorical distinctiveness among bulimic syndromes whereas other features (purging, binge eating, and weight) may do so only in specific combinations. Uniform severity criteria may be appropriate across bulimic syndromes.

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“…This is in line with a recent study of BN and PD that found the size of binge episodes explained additional variance in general and ED-related features beyond loss of control, and the relationship between loss of control eating, purging frequency, and depressive symptoms was stronger with larger binge sizes (Forney, Bodell, Haedt-Matt, & Keel, 2016). Furthermore, given suggestions that purging behavior may function to temporarily reduce aversive affective experiences associated with binge eating (Haedt-Matt & Keel, 2011), the lack of OBEs in PD may mitigate one of the primary functions of purging that serves to maintain and potentially exacerbate the behavior in other EDs characterized by OBEs.…”

Section: Discussionmentioning

confidence: 99%

A review of purging disorder through meta-analysis.

Lavender¹

2017

Journal of Abnormal Psychology

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Although a growing body of research has examined Purging Disorder (PD), there remains a lack of conclusive evidence regarding the diagnostic validity of PD. This meta-analysis compared PD to DSM–5 eating disorders (i.e., Anorexia Nervosa [AN], Bulimia Nervosa [BN], and Binge Eating Disorder [BED]) and controls. A comprehensive literature search identified 38 eligible studies. Group differences on indicators of course of illness and both general and eating psychopathology were assessed using standardized effect sizes. Results supported the conceptualization of PD as a clinically significant eating disorder, but findings were less clear regarding its distinctiveness from other eating disorder diagnoses. More specifically, PD significantly differed from BN and BED in natural course of illness (g = .40–.54), and PD significantly differed from AN in treatment outcome (g = .27), with PD characterized by a better prognosis. Overall, PD was more similar to AN and BED on many dimensional measures of general and eating-related psychopathology, though PD was less severe than BN in most of these domains. PD, BN, and BED groups also evidenced similar frequencies of subjective binge episodes (SBEs), yet PD evidenced less frequent SBEs than AN. There is a clear need for future studies of PD to assess validators that have not been reported comprehensively in the literature, such as mortality, medical morbidity, and course of illness. Additionally, empirical classification studies are needed to inform future classifications of PD, particularly with regard to categorical differences between PD and other eating disorders.

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Personality pathology in purging disorder and bulimia nervosa

Cited by 32 publications

References 22 publications

Clinical characteristics and distinctiveness of DSM-5 eating disorder diagnoses: findings from a large naturalistic clinical database

Clinical characteristics and distinctiveness of DSM-5 eating disorder diagnoses: findings from a large naturalistic clinical database

Evaluating new severity dimensions in the DSM‐5 for bulimic syndromes using mixture modeling

A review of purging disorder through meta-analysis.

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