A preliminary evaluation of the validity of binge‐eating disorder defining features in a community‐based sample

Abstract

Objective-Little empirical attention has been paid to the DSM-5 definition of Binge Eating Disorder (BED), particularly to the associated features of binge episodes. The present study sought to determine how the associated features and undue influence of weight/shape on self-evaluation contribute to evidence of a clinically significant eating disorder.Method-Secondary analyses were conducted on data (N = 80; 76.3% women, 76.3% Caucasian, ages 18-43) collected through an epidemiological study of eating patterns. Descriptive statistics were used to report the sample prevalence of the features, independently and in combination. Correlations and alpha reliability were employed to examine relationships among associated features, distress regarding bingeing, and clinical diagnosis. Regression models and receiveroperating characteristic (ROC) curves were used to determine the utility of the features for explaining variance in distress.Results-Internal consistency reliability for indicators was low, and several features demonstrated low or non-significant associations with distress and diagnosis. Feeling disgusted/ depressed/guilty was the only unique predictor of distress (p = 0.001). For the ROC curves, three features was the best threshold for predicting distress.Discussion-Results support the need to refine the features to ensure better detection of clinically significant eating pathology for research inclusion and treatment of the illness.Few studies (1-3) have examined the validity of the five associated features of binge-eating episodes, three of which, along with distress regarding bingeing, are required for a Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnosis of Binge Eating Disorder (BED). (4) Further, limited data exist regarding prevalence of these features, and it remains unclear how many features are central to defining BED. Additionally, controversy exists regarding if and how a body image disturbance criterion, namely, "the undue influence of body weight or shape on self-evaluation," (4) should be incorporated in the BED diagnosis (5-8). The present study sought to describe the prevalence of the associated features and determine how those features and undue influence relate to distress regarding binge eating and clinical diagnosis. Overall, we aimed to conduct a preliminary examination of the DSM-5 BED criteria, given that research conducted on BED populations rests on the assumption that the criteria accurately capture the abnormal eating behaviors they are intended to describe. HHS Public Access METHODS ParticipantsThe present study used data collected in 2002 from college cohorts established in 1982, 1992, and 2002 (N = 2060, 71% participation rate); inclusion and exclusion criteria are found in Table 1, and the larger epidemiological study is described in detail elsewhere. (9-11) Participants were also excluded if they were missing data needed to assess the main study variables. This yielded a sample size of N = 80 (76.3% women, mean (SD) age = 28.26 (8.22)) that was 76.3...

A preliminary study of momentary, naturalistic indicators of binge‐eating episodes in adults with obesity

“…Therefore, individuals evaluated for BED are required to characterize “typical” binge‐eating episodes over the past three months, which may produce recall errors. Retrospective research suggests that the presence of DSM indicators predicts BED diagnostic status (White & Grilo, ), while other data suggest that the indicators have poor internal consistency and do not reliably predict eating‐related distress in community samples (Klein, Forney, & Keel, ).…”

“…Retrospective research suggests that the presence of DSM indicators predicts BED diagnostic status (White & Grilo, 2011), while other data suggest that the indicators have poor internal consistency and do not reliably predict eating-related distress in community samples (Klein, Forney, & Keel, 2016).…”

Indicators of clinical significance among women in the community with binge‐eating disorder symptoms: Delineating the roles of binge frequency, body mass index, and overvaluation

“…On the other hand, overvaluation has also been recently found not to predict distress related to binge eating in a community sample (Klein, Forney, & Keel, 2016). Concerning the role of obesity, adults with BED in the general population are around three times more likely than people without eating disorders to be mild to moderately obese and 6.5 times more likely to be severely obese (Kessler et al, 2013).…”

Are the Criterion B binge‐eating symptoms interchangeable in understanding binge‐eating severity? An item response theory analysis

“…The authors also tested both positive and negative predictive power to identify a Criterion B symptom threshold that maximized identification of binge-eating cases and minimized false positives, with results supporting the current threesymptom threshold for identifying binge eating in a BED/BN sample. Klein et al (2016) assessed how each Criterion B symptom was associated with distress in a majority-BED sample. Logistic regression revealed that "feeling disgusted/depressed/guilty" (B5) was the only Criterion B symptom that uniquely predicted distress about binge eating or associated weight gain.…”