Examining the placement of atypical anorexia nervosa in the eating disorder diagnostic hierarchy relative to bulimia nervosa and binge‐eating disorder

Abstract

ObjectiveSome individuals meet the criteria for atypical anorexia nervosa and another eating disorder simultaneously. The current study evaluated whether allowing a diagnosis of atypical anorexia nervosa to supersede a diagnosis of bulimia nervosa (BN) or binge‐eating disorder (BED) provided additional information on psychological functioning.MethodsArchival data from 650 university students (87.7% female, 69.4% white) who met Eating Disorder Diagnostic Survey for DSM‐5 eating disorder criteria and completed questionnaires assessing quality of life, eating disorder‐related impairment, and/or eating pathology at a single time point. Separate regression models used diagnostic category to predict quality of life and impairment. Two diagnostic schemes were used: the DSM‐5 diagnostic scheme and an alternative scheme where atypical anorexia nervosa superseded all diagnoses except anorexia nervosa. Model fit was compared using the Davidson–Mackinnon J test. Analyses were pre‐registered (https://osf.io/2ejcd).ResultsAllowing an atypical anorexia nervosa diagnosis to supersede a BN or BED diagnosis provided better fit to the data for eating disorder‐related impairment (p = .02; n = 271), but not physical, psychological, or social quality of life (p's ≥ .33; n = 306). Allowing an atypical anorexia nervosa diagnosis to supersede a BN or BED diagnosis provided a better fit in cross‐sectional models predicting purging (p = .02; n = 638), but not body dissatisfaction, binge eating, restricting, or excessive exercise (p's ≥ .08; n's = 633–647).DiscussionThe current data support retaining the DSM‐5 diagnostic scheme. More longitudinal work is needed to understand the predictive validity of the atypical anorexia nervosa diagnosis.Public SignificanceThe current study examined how changes to the diagnostic categories for eating disorders may change how diagnoses are associated with quality of life and impairment. Overall, findings suggest that the diagnostic hierarchy should be maintained.

Time to revisit the definition of atypical anorexia nervosa

“…However, Keegan and Wade (2024) found that among individuals with BN receiving outpatient treatment, higher levels of readiness and confidence to change had steeper decreases in symptoms; no such relationship was observed among individuals with atypical AN. In a study of university students, Forney et al (2024) found that a large number of individuals met criteria for atypical AN and either BN or binge-eating disorder (BED) and examined advantages and disadvantages of allowing a diagnosis of atypical AN to supersede ("trump") a diagnosis of BN or BED. Although findings were mixed, the results suggested that the current DSM-5 hierarchy, in which a diagnosis of BN or BED supersedes that of atypical AN (and other OSFEDs), should be maintained.…”