The validity of DSM‐5 severity specifiers for anorexia nervosa, bulimia nervosa, and binge‐eating disorder

Abstract

Objective The DSM-5 includes severity specifiers (i.e., mild, moderate, severe, extreme) for anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED), which are determined by weight status (AN) and frequencies of binge-eating episodes (BED) or inappropriate compensatory behaviors (BN). Given limited data regarding the validity of eating disorder (ED) severity specifiers, this study examined the concurrent and predictive validity of severity specifiers in AN, BN, and BED. Method Adults with AN (n = 109), BN (n = 76), and BED (n = 216) were identified from previous datasets. Concurrent validity was assessed by measures of ED psychopathology, depression, anxiety, quality of life, and physical health. Predictive validity was assessed by ED symptoms at the end of the treatment in BN and BED. Results Severity categories did not differ in baseline validators, though the mild AN group evidenced greater ED symptoms compared to the severe group. In BN, greater severity was related to greater end of treatment binge-eating and compensatory behaviors, and lower likelihood of abstinence; however, in BED, greater severity was related to lower ED symptoms at the end of the treatment. Discussion Results demonstrated limited support for the validity of DSM-5 severity specifiers. Future research is warranted to explore additional validators and possible alternative indicators of severity in EDs.

An investigation of indirect effects of personality features on anorexia nervosa severity through interoceptive dysfunction in individuals with lifetime anorexia nervosa diagnoses

“…Although BMI is widely used in distinguishing those with and without AN, the lack of expected relationships may indicate that BMI is not a sufficient indicator of severity among those with AN, consistent with recent findings (Smith et al, 2017). Although significant correlations were found for perfectionism and ID for BMI, none of the variables of interest were significantly related to lifetime lowest BMI in structural models.…”

“…Although significant correlations were found for perfectionism and ID for BMI, none of the variables of interest were significantly related to lifetime lowest BMI in structural models. Although BMI is widely used in distinguishing those with and without AN, the lack of expected relationships may indicate that BMI is not a sufficient indicator of severity among those with AN, consistent with recent findings (Smith et al, 2017). This reinforces the importance of considering behavioral and psychological components when determining recovery status, rather than relying solely on physical parameters, such as BMI (Bardone-Cone et al, 2010).…”

A new approach to eating‐disorder classification: Using empirical methods to delineate diagnostic dimensions and inform care

“…The DSM ‐5 introduced new dimensional severity ratings for EDs, yet research that tested the validity and utility of the DSM ‐5 severity indices for EDs has been mixed. Studies found that severity indices did not meaningfully differentiate clients on the basis of psychosocial impairment or associated psychopathology (Jenkins, Luck, Cardy, & Staniford, ; Machado, Grilo, & Crosby, ; Reas & Rø, ; Smith et al, ), showed mixed support (Gianini et al, ; Grilo, Ivezaj, & White, b), or found that severity indices were significant predictors of important outcomes (Dakanalis, Colmegna, Riva, & Clerici, ; Dakanalis, Riva, Serino, Colmegna, & Clerici, ; Grilo, Ivezaj, & White, ). A limitation of the severity dimensions for EDs is that they ignore important trans‐diagnostic information about non‐ED aspects of internalizing psychopathology that may be the focus of clinical attention, such as suicidality.…”

“…The DSM-5 introduced new dimensional severity ratings for EDs, yet research that tested the validity and utility of the DSM-5 severity indices for EDs has been mixed. Studies found that severity indices did not meaningfully differentiate clients on the basis of psychosocial impairment or associated psychopathology (Jenkins, Luck, Cardy, & Staniford, 2016;Machado, Grilo, & Crosby, 2017;Reas & Rø, 2017;Smith et al, 2017), showed mixed support (Gianini et al, 2017 (Manchia et al, 2013;Wray & Maier, 2014). Incorporation of Hi-TIDE constructs into genetic research could increase statistical power by providing homogenous and dimensional phenotypes at each level of the hierarchy.…”

Investigating resting brain perfusion abnormalities and target-engagement by intranasal oxytocin in women with bulimia nervosa and binge-eating disorder and healthy controls

“…Bulimia nervosa (BN) and binge eating disorder (BED) are psychiatric disorders characterized by recurrent binge eating 1 . In BN, binge eating is accompanied by excessive compensatory behaviours, which are absent in BED 2 .…”