Mild, moderate, meaningful? Examining the psychological and functioning correlates of DSM‐5 eating disorder severity specifiers

Abstract

Objective This study evaluated the DSM-5 severity specifiers for treatment-seeking groups of participants with anorexia nervosa (AN), the purging form of bulimia nervosa (BN), and binge eating disorder (BED). Method 162 participants with AN, 93 participants with BN, and 343 participants with BED were diagnosed using semi-structured interviews, sub-categorized using DSM-5 severity specifiers and compared on demographic and cross-sectional clinical measures. Results In AN, the number of previous hospitalizations and the duration of illness increased with severity, but there was no difference across severity groups on measures of eating pathology, depression, or measures of self-reported physical or emotional functioning. In BN, the level of eating concerns increased across the severity groups, but the groups did not differ on measures of depression, self-esteem, and most eating pathology variables. In BN, support was also found for an alternative severity classification scheme based upon number of methods of purging. In BED, levels of several measures of eating pathology and self-reported physical and emotional functioning increased across the severity groups. For BED, however, support was also found for an alternative severity classification scheme based upon overvaluation of shape and weight. Preliminary evidence was also found for a transdiagnostic severity index based upon overvaluation of shape and weight. Discussion Overall, these data show limited support for the DSM-5 severity specifiers for BN and modest support for the DSM-5 severity specifiers for AN and BED.

Core psychopathology in anorexia nervosa and bulimia nervosa: A network analysis

“…Currently, the hallmark behaviors for ED types are used to indicate illness severity: restrictive eating leading to a significantly low weight for AN, compensatory behavior frequencies for BN, and binge‐eating frequencies for BED (American Psychiatric Association, ). As Giannini and colleagues () describe, ideal indicators of illness severity would index “the intensity of defining psychopathological features of the illness” (p. 914)—a goal that closely aligns with those of network analysis. Interestingly, ED behaviors did not play a principal role in comprising the ED psychopathology structures, which may suggest that current severity specifiers do not fully capture defining ED features.…”

“…Most participants (AN = 81.6%, BN = 88.5%; see Table ) reported clinically significant shape or weight overvaluation, as indicated by responses ≥4 on either EDE‐Q item 22 (weight overvaluation) or item 23 (shape overvaluation; e.g., Giannini et al, ). This clinical cutoff was not used as an inclusion criterion, as diagnostic interviews were conducted separately from EDE‐Q completion.…”

The impact of DSM‐5 on the diagnosis and severity indicator of eating disorders in a treatment‐seeking sample

“…In the BN and BED groups, higher severity ratings were associated with higher level of eating concern on the EDE‐Q, but the severity groups did not differ on other eating pathology variables. Although studies on the evaluation of the DSM‐5 severity indicators for BN have produced mixed findings (Dakanalis, Clerici et al, 2017; Gianini et al, ; Jenkins et al, ), studies in clinical samples with BED found levels of several measures of eating pathology increased as severity increases (Dakanalis, Riva et al, 2017; Gianini et al, ; Grilo et al, ). Participants with BED in these studies were mostly obese.…”

“…One study reported that the severity groups did not differ on cross‐sectional measures of eating disorder psychopathology or on the frequency of binge eating or purging episodes in a clinical sample of individuals with AN (Machado, Grilo, & Crosby, ). Furthermore, Gianini et al () reported that the number of previous hospitalizations and the duration of illness increased with the severity for AN, but there was no difference across severity groups on measures of eating pathology, depression, or measures of self‐reported physical or emotional functioning in AN.…”

“…One study in a nonclinical community sample reported modest differences in eating disorder pathology and depression between the severity groups for BN, but effect sizes were small (Grilo, Ivezaj, & White, ). Gianini et al () reported that the severity groups did not differ on measures of depression, self‐esteem and most eating pathology variables in BN.…”