Incorporating dimensions into the classification of eating disorders: three models and their implications for research and clinical practice (original) (raw)
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Clinical Psychology Review, 2013
There is increasing recognition of the limitations of current approaches to psychiatric classification. Nowhere is this more apparent than in the eating disorders (EDs). Several alternative methods of classifying EDs have been proposed, which can be divided into two major groups: 1) those that have classified individuals on the basis of disordered eating symptoms; and, 2) those that have classified individuals on the basis of comorbid psychopathology and associated features. Several reviews have addressed symptom-based approaches to ED classification, but we are aware of no paper that has critically examined comorbidity-based systems. Thus, in this paper, we review models of classifying EDs that incorporate information about comorbid psychopathology and associated features. Early approaches are described first, followed by more recent scholarly contributions to comorbidity-based ED classification.
Classification of eating disorders: Toward DSM-V
International Journal of Eating Disorders, 2007
Objective: A goal of the DSM-IV revision is to increase clinical and research utility by improving diagnostic validity through reliance on empirical evidence. Currently defined eating disorder (ED) categories have limited validity and require refinement based on data. Method: The available scientific evidence is considered in evaluating the current ED nosology. Results: Specific recommendations include modifying ED classification by retaining categories but adding a dimensional component; removing the amenorrhea criterion for anorexia nervosa (AN); removing the subtypes for AN and bulimia nervosa (BN); making binge eating disorder (BED) an official diagnosis; and unifying the frequency and duration cut-points for BN and BED to once per week for 3 months. Priority research areas should include epidemiologic studies of full-range ED symptomatology and should focus on empirical validation for individual criterion. Conclusion: There are significant issues to address in revising ED nosology as we move toward a more valid and useful DSM-V. V V
Dimensional assessment of personality pathology in patients with eating disorders
Psychiatry Research, 1999
This study examined patients with eating disorders on personality pathology using a dimensional method. Female Ž . subjects who met DSM-IV diagnostic criteria for eating disorder n s 136 were evaluated and compared to an Ž . age-controlled general population sample n s 68 . We assessed 18 features of personality disorder with the Ž . Dimensional Assessment of Personality Pathology ᎏ Basic Questionnaire DAPP-BQ . Factor analysis and cluster analysis were used to derive three clusters of patients. A five-factor solution was obtained with limited intercorrelation between factors. Cluster analysis produced three clusters with the following characteristics: Cluster 1 members Ž . constituting 49.3% of the sample and labelled 'rigid' had higher mean scores on factors denoting compulsivity and Ž . interpersonal difficulties; Cluster 2 18.4% of the sample showed highest scores in factors denoting psychopathy, Ž neuroticism and impulsive features, and appeared to constitute a borderline psychopathology group; Cluster 3 32.4%
Empirical Classification of Eating Disorders
Annual Review of Clinical Psychology, 2012
Current diagnostic criteria for anorexia nervosa (AN) and bulimia nervosa (BN) account for a minority of individuals with clinically significant disorders of eating, raising concerns about the clinical utility of current definitions. This review examines evidence for the validity of current and alternative approaches to defining eating disorders and implications for draft criteria for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Although this review largely supports the predictive validity of distinctions among AN, BN, and the newly proposed binge eating disorder (BED), it also highlights that our tendency to "study what we define" has created a gap between the problems that people have and what we know about those problems. Future research on the causes and consequences of eating disorders should include more heterogeneous groups to enable identification of meaningful boundaries that distinguish between disorders based on etiological and predictive validity.
Views on Classification and Diagnosis of Eating Disorders
The Canadian Journal of Psychiatry, 1995
Objective To highlight developments in the taxonomy of eating disorders since Russell's original description of bulimia nervosa (BN) in 1979 and through 3 versions of the Diagnostic and Statistical Manual. Method Criteria for anorexia nervosa (AN), BN and binge eating disorder (BED) are systematically described. Results While criteria for AN remain largely unchanged between DSM-III-R and DSM-IV, the subclassification of binge/purge and restricter subgroups endorses previous research findings. For BN, the definition of “binge” has occupied considerable attention both in quantitative and qualitative terms. The arbitrary choice of 2 episodes per week as a minimum frequency is also discussed in light of recent data from the Ontario Health Supplement. A third eating disorder, BED, is now included in the appendix of DSM-IV under Eating Disorders — Not Otherwise Specified category. The potential overlap between this disorder and nonpurging BN is discussed. Finally, the relationship bet...
Personality Profiles in Eating Disorders: Rethinking the Distinction Between Axis I and Axis II
American Journal of Psychiatry, 2001
Objective: Like other DSM-IV axis I syndromes, eating disorders are diagnosed without respect to personality, which is coded on axis II. The authors assessed the utility of segregating eating disorders and personality pathology and examined the extent to which personality patterns account for meaningful variation within axis I eating disorder diagnoses. Method: One hundred three experienced psychiatrists and psychologists used a Qsort procedure (the Shedler-Westen Assessment Procedure-200) that assesses personality and personality pathology to describe a patient they were currently treating for bulimia or anorexia. Data were subjected to a cluster-analytic procedure (Q-analysis) to determine whether patients clustered into coherent groupings on the basis of their personality profiles. Categorical and dimensional personality diagnoses were then used to predict measures relevant to adaptation and etiology, controlling for axis I diagnosis. Results: Three categories of patients emerged: a high-functioning/perfectionis-tic group, a constricted/overcontrolled group, and an emotionally dysregulated/ undercontrolled group. This categorization demonstrated substantial incremental validity beyond axis I diagnosis in predicting eating disorder symptoms, adaptive functioning (Global Assessment of Functioning scores and history of psychiatric hospitalization), and etiological variables (sexual abuse history). Conclusions: Axis I symptoms are a useful component, but only one component, in the accurate diagnosis of eating disorders. Classifying patients with eating disorders by eating symptoms alone groups together patients with anorexic symptoms who are high functioning and self-critical with those who are highly disturbed, constricted, and avoidant, and groups together patients with bulimic symptoms who are high functioning and self-critical with those who are highly disturbed, impulsive, and emotionally dysregulated. These distinctions may be relevant to etiology, prognosis, and treatment.
Journal of the American …, 2010
Objective-The purpose of this study was to empirically derive eating disorder phenotypes in a clinical sample of children and adolescents using latent profile analysis (LPA) and compare these latent profile (LP) groups to the DSM-IV-TR eating disorder categories. Method-Eating disorder symptom data collected from 401 youth (ages 7-19; mean 15.14 ± 2.35y) seeking eating disorder treatment were included in LPA; general linear models were used to compare LP groups to DSM-IV-TR eating disorder categories on pre-treatment and outcome indices. Results-Three LP groups were identified: LP1 (n=144), characterized binge eating and purging ("Binge/purge"); LP2 (n=126), characterized by excessive exercise and extreme eating disorder cognitions ("Exercise-extreme cognitions"); and LP3 (n=131), characterized by minimal eating disorder behaviors and cognitions ("Minimal behaviors/cognitions"). Identified LPs imperfectly resembled DSM-IV-TR eating disorders. LP1 resembled bulimia nervosa; LP2 and LP3 broadly resembled anorexia nervosa with a relaxed weight criterion, differentiated by excessive exercise and severity of eating disorder cognitions. LP groups were more differentiated than the DSM-IV-TR categories across pre-treatment eating disorder and general psychopathology indices, as well as weight change at follow-up. Neither LP nor DSM-IV-TR categories predicted change in binge/purge behaviors. Validation analyses suggest these empirically-derived groups improve upon the current DSM-IV-TR categories. Conclusions-In children and adolescents, revisions for DSM-V should consider recognition of patients with minimal cognitive eating disorder symptoms.
COMMENTARY Thinking Afresh about the Classification of Eating Disorders
2013
The DSM-IV scheme for classifying eating disorders 1 has certain fundamental flaws. Most prominent among them is the fact that the supposedly ‘‘residual’ ’ diagnostic category, eating disorder not otherwise specified (EDNOS), is the most common eating disorder encountered in clinical practice: it is more common than the two specified eating disorders, anorexia nervosa (AN) and bulimia nervosa (BN). This is firmly established among adults who are outpatients, 2–7 and now Rockert et al. have demonstrated that this is true of those attending a tertiary care outpatient center. 8 It also seems to be the case in inpatient settings 9 and among adolescent cases. 10,11 A second problem concerns the utility of the current diagnostic distinctions. Their arbitrariness is immediately apparent when working with patients. This is especially obvious when one follows patients over time as migration between the eating disorder diagnoses is the norm rather than the exception. Many cases of AN evolve i...
Comments on the proposed criteria for eating disorders in DSM IV
European Eating Disorders Review, 1994
The American Psychiatric Association (APA) soon will publish a new system for the classification of psychiatric illnesses, DSM IV. It is likely to become the accepted scheme throughout the world for at least the next decade, exerting a strong influence on clinical work and research (Kendell, 1991). With admirable openness, the APA has promulgated widely the deliberations of the committees charged with designing the new classificatory system, actively seeking comments from American and overseas experts. Proposals were set out in an Options book, and a series of Draft Criteria have now been published (American Psychiatric Association, 1993) from which a fair idea can be gained of how the final version will look. There is an extensive accompanying text, sections of which have also been circulated to consultants with a special interest in the various areas of classification. Field trial results have been assessed and the proposed criteria discussed at the APA's Annual Meeting in May, with a view to publication of the final form of DSM IV early in 1994. While members of the American Association have had ample opportunity to express their views, it is important that other professional groups throughout the world also voice their opinions of the new system as they too will be affected by its implementation. The purpose of the present paper is to present a critical appraisal of the proposed criteria for eating disorders in DSM IV. GENERAL ISSUES The diagnostic criteria for eating disorders have been thoroughly revised, and some of the anomalies apparent in DSM IIIR (American Psychiatric Association, 1987) have been addressed satisfactorily: (a) In DSM IIIR, the whole section on Eating Disorders had been placed in the chapter on 'Disorders first manifest in childhood and adolescence'. Although it is difficult to determine the precise onset of an illness such as anorexia nervosa (Beumont et al., 1978), most reports suggest a ~~