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Impact of altering DSM-IV criteria for anorexia and bulimia nervosa on the base rates of eating disorder diagnoses

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Abstract

The diagnostic criteria used to define eating disorders have been the focus of debate for many years. The primary aim of this study was to evaluate the impact of altering DSM-IV diagnostic criteria upon the base rates of anorexia nervosa (AN), bulimia nervosa (BN) and eating disorder not otherwise specified (EDNOS). Five controversial criteria were systematically modified and the impact of these changes on base rates of full-syndrome and partial-syndrome eating disorders was assessed in 193 patients referred to two specialty eating disorder clinics. Modification of a single criterion resulted in relatively small changes in base rates of AN and BN, whereas modification of the two severity criteria led to more substantial changes. These findings have significant implications for future modifications of the DSM classification.

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References

  1. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington DC., A.P.A. Press, 1994.

    Google Scholar 

  2. Garfinkel P.E., Lin B., Goering P., Spegg C., Goldbloom D., Kennedy S., Kaplan A., Woodside B.: Bulimia nervosa in a Canadian community sample: Prevalence, co-morbidity, early experiences and psychosocial functioning. Am. J. Psychiatry, 152, 1052–1058, 1995.

    CAS  PubMed  Google Scholar 

  3. Kendler K.S., MacLean C., Neale M., Kessler R., Heath A., Eaves L.: The genetic epidemiology of bulimia nervosa. Am. J. Psychiatry, 148, 1627–1637, 1991.

    CAS  PubMed  Google Scholar 

  4. Whitaker A.H.: An epidemiological study of anorectic and bulimic symptoms in adolescent girls: Implications for pediatricians. Pediatr. Ann., 21, 752–759, 1992.

    CAS  PubMed  Google Scholar 

  5. Womble L.G., Williamson D.A., Smeets M.A.: Three dimensional structure of DSM-IV diagnostic symptoms for eating disorders: Implications for behavioral assessment. Poster presented at the 32nd Annual Convention of the Association for the Advancement of Behavior Therapy, lescents. J. Am. Acad. Child Adolesc. Psychiatry, 36, 1116–1123, 1997.

    Article  Google Scholar 

  6. Button E.J., Whitehouse A.: Subclinical anorexia nervosa. Psychol. Med., 11, 509–516, 1981.

    Article  CAS  PubMed  Google Scholar 

  7. Dancyger I.F., Garfinkel P.E.: The relationship of partial syndrome eating disorders to anorexia nervosa and bulimia nervosa. Psychol. Med., 25, 1019–1025, 1995.

    Article  CAS  PubMed  Google Scholar 

  8. Heatherton T.F., Nichols P., Mahamedi F., Keel P.: Body weight, dieting and eating disorders symptoms among college students, 1982–1992. Am. J. Psychiatry, 152, 1623–1629, 1995.

    CAS  PubMed  Google Scholar 

  9. Stein D., Meged S., Bar-Hanin T., Blank S., Elizur A., Weizman A.: Partial eating disorders in a community sample of female adolescents. J. Am. Acad. Child Adolesc. Psychiatry, 36, 1116–1123, 1997.

    Article  CAS  PubMed  Google Scholar 

  10. Fairburn C.G., Wilson T.G.: Binge eating: Definition and classification. In: Fairburn C.G., Wilson G.T. (Eds.), Binge eating: Nature, assessment and treatment. New York, Guilford Press, 1993, pp. 3–14.

    Google Scholar 

  11. Bunnell D.W., Cooper P.J., Hertz S., Shenker I.R.: Body shape concerns among adolescents. Int. J. Eat. Disord., 11, 79–83, 1992.

    Article  Google Scholar 

  12. Bunnell D.W., Shenker I.R., Nussbaum M.P., Jacobson M.S., Cooper P.: Subclinical versus formal eating disorders: Differentiating psychological features. Int. J. Eat. Disord., 9, 357–362, 1990.

    Article  Google Scholar 

  13. Herzog D.B., Hopkins J.D., Burns C.D.: A follow-up study of 33 sub-diagnostic eating disordered women. Int. J. Eat. Disord., 14, 261–267, 1993.

    Article  CAS  PubMed  Google Scholar 

  14. Kutlesic V., Williamson D.A., Gleaves D.H., Barbin J.M., Murphy-Eberenz K.P.: The Interview for the Diagnosis of Eating Disorders — IV: Application to DSM-IV diagnostic criteria. Psychological Assessment, 10, 41–48, 1998.

    Article  Google Scholar 

  15. Williamson D.A., Gleaves D.H., Savin S.M.: Empirical classification of eating disorder NOS: Support for DSM-IV changes. J. Psychopat., 14, 201–216, 1992.

    Google Scholar 

  16. Dally P.J.: Anorexia nervosa. New York, Grune & Stratton, 1969.

    Google Scholar 

  17. Feighner J.P., Robins E., Guze S.B., Wooddruff R.A. Jr., Winokur G., Munoz R.: Diagnostic criteria for use in psychiatric research. Arch. Gen. Psychiatry, 26, 57–63, 1972.

    Article  CAS  PubMed  Google Scholar 

  18. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 3rd ed. Washington DC., A.P.A. Press, 1987.

    Google Scholar 

  19. Pirke K.M., Ploog D.: Biology of human starvation. In: Beumont P.J.V., Burrows G.D., Casper R.C. (Eds.), Handbook of Eating Disorders Part 1: Anorexia and Bulimia Nervosa. New York, Elsevier, 1987, pp. 79–102.

    Google Scholar 

  20. Theander S.: Anorexia nervosa: A psychiatric investigation of 94 female patients. Acta Psychiatr. Scand., 214 (Suppl.), 1–194, 1970.

    CAS  Google Scholar 

  21. Walsh B.T., Garner D.M.: Diagnostic issues. In: Garner D.M., Garfinkel P.E. (Eds.), Handbook of Treatment for Eating Disorders, 2nd ed. New York, Guilford Press, 1997, pp. 25–33.

    Google Scholar 

  22. Cachelin F.M., Maher B.A.: Restrictors who purge: Implications of purging behavior for psychopathology and classification of anorexia nervosa. Eating Disorders: The Journal of Treatment and Prevention, 6, 51–63, 1998.

    Article  Google Scholar 

  23. Garfinkel P.E., Lin E., Goering P., Spegg C., Goldbloom D., Kennedy S., Kaplan A.S., Woodside D.B.: Should amenorrhoea be necessary for the diagnosis of anorexia nervosa? Evidence from a Canadian community sample. Br. J. Psychiatry, 168, 500–506, 1996.

    Article  CAS  PubMed  Google Scholar 

  24. Andersen A.E., Holman J.E.: Males with eating disorders: Challenges for treatment and research. Psychopharmacol. Bull., 33, 391–397, 1997.

    CAS  PubMed  Google Scholar 

  25. Beglin S.J., Fairburn C.G.: What is meant by the term “binge”? Am. J. Psychiatry, 149, 123–124, 1992.

    CAS  PubMed  Google Scholar 

  26. Garner D.M., Shafer C.L., Rosen L.W.: Critical appraisal of the DSM-III-R diagnostic criteria for eating disorders. In: Hooper S.R., Hynd G.W., Mattison R.E. (Eds.), Child psychopathology: Diagnostic criteria and clinical assessment. Hillsdale, NJ, Erlbaum, 1992, pp. 261–303.

    Google Scholar 

  27. Pratt E.M., Niego S.H., Agras W.S.: Does the size of the binge matter? Int. J. Eat. Disord., 24, 307–312, 1998.

    Article  CAS  PubMed  Google Scholar 

  28. Rossiter E.M., Agras W.S.: An empirical test of the DSM-III-R definition of binge. Int. J. Eat. Disord., 9, 513–518, 1990.

    Article  Google Scholar 

  29. Gleaves D.H., Williamson D.A., Barker S.E.: Confirmatory factor analysis of a multidimensional model of bulimia nervosa. J. Abnorm. Psychol., 102, 177–180. 1993.

    Article  PubMed  Google Scholar 

  30. Rosen J.C., Leitenberg H., Fisher C., Khazam C.: Binge-eating episodes in bulimia nervosa: The amount and type of food consumed. Int. J. Eat. Disord., 5, 255–267, 1986.

    Article  Google Scholar 

  31. Rossiter E.M., Agras W.S.: An empirical test of the DSM-III-R definition of binge. Int. J. Eat. Disord., 9, 513–518, 1990.

    Article  Google Scholar 

  32. Wilson G.T., Eldredge K.L.: Frequency of binge eating in bulimic patients: Diagnostic validity. Int. J. Eat. Disord., 10, 557–561, 1991.

    Article  Google Scholar 

  33. Williamson D.A.: Assessment of eating disorders: obesity, anorexia, and bulimia nervosa. New York, Pergamon Press, 1990.

    Google Scholar 

  34. Hadigan C.M., Walsh B.T.: Body shape concerns in bulimia nervosa. Int. J. Eat. Disord., 10, 323–331, 1991.

    Article  Google Scholar 

  35. Cooper P.J., Goodyer I.: Prevalence and significance of weight and shape concerns in girls aged 11–16 years. Br. J. Psychiatry, 171, 542–544, 1997.

    Article  CAS  PubMed  Google Scholar 

  36. Ben-Tovim D.I.: DSM-III, draft DSM-III-R, and the diagnosis and prevalence of bulimia in Australia. Am. J. Psychiatry, 145, 1000–1002, 1988.

    CAS  PubMed  Google Scholar 

  37. Russell G.F.M.: Bulimia nervosa: An ominous variant of anorexia nervosa. Psychol. Med., 9, 429–448, 1979.

    Article  CAS  PubMed  Google Scholar 

  38. Beumont P.J.V., Garner D.M., Touyz S.W.: Diagnoses of eating or dieting disorders: What may we learn from past mistakes? Int. J. Eat. Disord., 16, 349–362, 1994.

    Article  CAS  PubMed  Google Scholar 

  39. Fairburn C.G., Welch S.L., Hay P.J.: The classification of recurrent overeating: The “binge eating disorder” proposal. Int. J. Eat. Disord., 13, 155–159, 1993.

    Article  CAS  PubMed  Google Scholar 

  40. Spitzer R.L., Yanovski S., Wadden T., Wing R., Marcus M.D., Stunkard A., Devlin M., Mitchell J., Hasin D., Horne R.L.: Binge eating disorder: Its further validation in a multisite study. Int. J. Eat. Disord., 13, 137–153, 1993.

    Article  CAS  PubMed  Google Scholar 

  41. Williamson D.A., Womble L.G., Smeets M. A.M., Netemeyer R.G., Thaw J.M., Kutlesic V., Gleaves D.H.: The latent structure of eating disorder symptoms: A factor analytic and taxometric investigation. Manuscript submitted for publication.

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Thaw, J.M., Williamson, D.A. & Martin, C.K. Impact of altering DSM-IV criteria for anorexia and bulimia nervosa on the base rates of eating disorder diagnoses. Eat Weight Disord 6, 121–128 (2001). https://doi.org/10.1007/BF03339761

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