Diagnostic Classification of Eating Disorders in Children and Adolescents: How Does DSM-IV-TR Compare to Empirically-Derived Categories?

Abstract

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.

Eating Disorders in Children and Adolescents: State of the Art Review

“…6 On the basis of the criteria from the fourth edition of the DSM, most adolescents were diagnosed with EDs not otherwise specified (EDNOS), a group of heterogeneous disorders composed primarily of subthreshold AN or BN. 13 The estimated lifetime prevalence of EDNOS in adolescents is 4.8%. 14 Rates of medical complications in EDNOS are similar to full-threshold disorders.…”

Neurocognitive functioning in adolescents with eating disorders: A population-based study

“…At least half of the patients seen at eating disorder treatment centres are diagnosed with an EDNOS (Eddy et al, 2010;Fairburn & Bohn, 2005), and individuals with EDNOS present similarly to those with AN and BN in terms of symptom severity and impairments in functioning (Turner & Bryant-Waugh, 2004). Past systematic reviews have tended to exclude EDNOS groups due to the heterogeneity of this diagnostic category (e.g., Van den Eynde et al, 2011), but this results in a large proportion of eating disorder cases being omitted from research.…”

Latent class analysis of eating and impulsive behavioral symptoms in Taiwanese women with bulimia nervosa

“…Several studies have identified subgroups of individuals resembling those with BN that are characterized by binge-eating and purging symptoms in both clinical and community populations by using latent class analysis (LCA) [30][31][32][33][34][35][36][37] or latent profile analysis (LPA) [38][39][40][41][42][43][44][45]. Latent class analysis seeks to identify the smallest number of identifiable latent classes (i.e., categories of a latent factor) that account for the association between three or more observed dichotomous and polychotomous variables [46,47].…”