Understanding eating disorders within internalizing psychopathology: A novel transdiagnostic, hierarchical-dimensional model

A new approach to eating‐disorder classification: Using empirical methods to delineate diagnostic dimensions and inform care

“…The lowest level of the hierarchy was characterized by 15 factors, which represented: binge eating, body dissatisfaction, lassitude (lack of energy and fatigue), negative attitudes toward obesity, excessive exercise, restricting, well‐being, obsessive–compulsive disorder (OCD) contamination‐mania, OCD checking‐mania, insomnia, social anxiety, purging, PTSD, and claustrophobia. The 15‐factor model replicated results of Forbush et al (), with a few notable exceptions. Similar to Forbush and colleagues (2017), the OCD factors included manic content related to racing thoughts and rapid speech.…”

“…For a visual depiction of the full hierarchy, please refer to the online Supporting Information. Our results were similar to Forbush et al (), except we did not find a Mindless Eating dimension, and the obsessive–compulsive/mania dimension bifurcated into two separate dimensions. Restricting and Insomnia appear twice in the figure, but were included only once in the statistical model.…”

“…Factor scores were saved and correlated with subordinate factors, which resulted in a hierarchical structure. In the current study, we modeled the extent to which all 15‐factors of the hierarchical model identified by Forbush et al () at baseline explained variance in 6‐month ED outcomes through ESEM. In a separate ESEM model, we tested the ability of all 13 categorical DSM internalizing disorders (assessed at baseline) to predict 6‐month ED outcomes (note: we defined outcome as the future status of patients at 6‐month or 1‐year follow‐up, rather than testing changes over time).…”

“…To distinguish our initial empirical model from the broader theoretical framework developed by the HiTOP consortium, we labeled our model Hierarchical Taxonomy of Internalizing Dimensions for Eating Disorders (Hi‐TIDE) (see Figure ). In the first study to test Hi‐TIDE, Forbush et al () found 15 dimensions that predicted nearly 70% of the variance in clinical impairment secondary to an ED. In contrast, all DSM ‐5 eating, mood, and anxiety disorders combined predicted slightly <11% of clinical impairment.…”

“…Results from the initial Hi‐TIDE model were promising; yet, it is not clear whether Hi‐TIDE will improve the ability to predict short‐term outcomes in persons with EDs, which is critical if a dimensional‐hierarchical model is to be useful in a clinical context. The primary goal of the current study was to compare the 15 Hi‐TIDE dimensions identified by Forbush et al () to 13 DSM‐ 5 mood, eating, and anxiety disorders to test which would best predict 6‐month ED outcomes. Our secondary goal was to compare the 1‐year stability of the Hi‐TIDE model to the DSM ‐5 model.…”