Testing the DSM-5 severity indicator for bulimia nervosa in a treatment-seeking sample

  • Antonios DakanalisEmail author
  • Massimo Clerici
  • Giuseppe Riva
  • Giuseppe Carrà
Original Article



This study tested the new DSM-5 severity criterion for bulimia nervosa (BN) based on the frequency of inappropriate weight compensatory behaviors in a treatment-seeking sample.


Participants were 345 adults with DSM-5 BN presenting for treatment. They were sub-grouped based on DSM-5 severity levels and compared on a range of variables of clinical interest and demographics.


Based on DSM-5 severity definitions, 27.2 % of the sample was categorized with mild, 26.1 % with moderate, 24.9 % with severe, and 21.8 % with extreme severity of BN. Analyses revealed that the four (mild, moderate, severe, and extreme) severity groups of BN significantly differed from each other in eating disordered and body-related attitudes and behaviors, factors involved in the maintenance process of the disorder, comorbid psychiatric disorders, psychological distress, and psychosocial impairment (medium-to-large effect sizes). No significant between-group differences were observed in demographics, body mass index, or at the age when BN first occurred, lending some credence to recent suggestions that age-at-onset of BN may be more a disorder- than a severity-dependent variable.


Collectively, our findings provide support for the severity indicator for BN introduced in the DSM-5 as a means of addressing heterogeneity and variability in the severity of the disorder.


DSM-5 Severity specifier Bulimia nervosa Treatment-seeking sample 


Compliance with ethical standards

Conflict of interest

This research received no specific grant from any funding agency, commercial or not for-profit sectors and the authors declare that they have no conflicts of interest.

Ethical approval

The study was performed in compliance with the Helsinki Declaration of 1975, as revised in 2008, and the study protocol was approved by the ethics review board of each local institution (recruitment/participating site) and of the co-ordinating body of the project (University of Pavia).

Informed consent

All participants provided written informed consent.


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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of Medicine and SurgeryUniversity of Milano BicoccaMonzaItaly
  2. 2.Department of Brain and Behavioral SciencesUniversity of PaviaPaviaItaly
  3. 3.Department of PsychologyCatholic UniversityMilanItaly
  4. 4.Applied Technology for Neuro-Psychology LaboratoryIstituto Auxologico Italiano, IRCCSMilanItaly
  5. 5.Division of Psychiatry, Faculty of Brain SciencesUniversity College of LondonLondonUK

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