How should DSM-V classify eating disorder not otherwise specified (EDNOS) presentations in women with lifetime anorexia or bulimia nervosa?
Open accessAbstract
Objective: Anorexia nervosa (AN) and bulimia nervosa (BN) are marked by longitudinal symptom fluctuations. DSM-IV-TR does not address how to classify eating disorder (ED) presentations in individuals who no longer meet full criteria for these disorders. To consider this issue, we examined subthreshold presentations in women with initial diagnoses of AN and BN. Method: A total of 246 women with AN or BN were followed for a median of 9 years; weekly symptom data were collected at frequent intervals using the Longitudinal Interval Follow-up Evaluation of Eating Disorders (LIFE-EAT-II). Outcomes were ED presentations that were subthreshold for ⩾3 months, including those narrowly missing full criteria for AN or BN, along with binge eating disorder (BED) and purging disorder. Results: During follow-up, most women (77.6%) experienced a subthreshold presentation. Subthreshold presentation was related to intake diagnosis (Wald χ 2=8.065, df=2, p=0.018). Individuals with AN most often developed subthreshold presentations resembling AN; those with BN were more likely to develop subthreshold BN. Purging disorder was experienced by half of those with BN and one-quarter of those with AN binge/purge type (ANBP); BED occurred in 20% with BN. Transition from AN or BN to most subthreshold types was associated with improved psychosocial functioning (p<0.001). Conclusions: Subthreshold presentations in women with lifetime AN and BN were common, resembled the initial diagnosis, and were associated with modest improvements in psychosocial functioning. For most with lifetime AN and BN, subthreshold presentations seem to represent part of the course of illness and to fit within the original AN or BN diagnosis.
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Differences in the correlates and clinical profiles between discrete subtypes in this study provide evidence for the validity of these distinctions.
“Although the frequent crossover of eating disorder subtypes in longitudinal studies of adults37–39 suggests a lack of diagnostic specificity of eating disorder subtypes,40–42 differences in the correlates and clinical profiles between discrete subtypes in our study provide evidence for the validity of these distinctions.”
From Prevalence and Correlates of Eating Disorders in Adolescents: Results From the National Comorbidity Survey Replication Adolescent Supplement (2011) · cites this paper as [37]
The cross-sectional design of this study limits conclusions concerning temporal relationships among comorbid conditions and prevents confirmation of findings from adult samples concerning eating disorder crossovers or transitions from subthreshold to full-threshold conditions.
“However, the cross-sectional design of this study limits conclusions concerning temporal relationships among comorbid conditions and prevents confirmation of findings from adult samples concerning eating disorder crossovers or transitions from subthreshold to full-threshold conditions.37–39”
From Prevalence and Correlates of Eating Disorders in Adolescents: Results From the National Comorbidity Survey Replication Adolescent Supplement (2011) · cites this paper as [37]
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Cites
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- Authors
- Eddy, K. T., Swanson, S. A., Crosby, R. D., Franko, D. L., Engel, S., & Herzog, D. B.
- Affiliations
- Massachusetts General Hospital (US)
- National Institute of Mental Health (US)
- University of North Dakota (US)
- Northwestern University (US)
- Corresponding author
- Eddy, K. T.
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2010-01-05
- Volume
- 40
- Issue
- 10
- Pages
- 1735-1744
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- PMC
- PMC3740170
- OpenAlex
- W2104694109
- Cited by
- 58
- References
- 15
- Citations by year
- 2025: 1 · 2024: 2 · 2023: 3 · 2022: 3 · 2021: 22 · 2020: 2 · 2019: 1 · 2018: 3 · 2017: 2 · 2016: 1 · 2015: 5 · 2014: 1 · 2013: 5 · 2012: 3
- FWCI
- 3.88
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Psychological Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (F32MH084396, R01MH038333)
- National Institute of Diabetes and Digestive and Kidney Diseases (P30DK040561)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Keywords
- eating disorder not otherwise specified, anorexia nervosa, bulimia nervosa, DSM-5 classification, binge eating disorder, purging disorder, women, psychosocial functioning, clinical course
- MeSH terms
- Anorexia, Feeding and Eating Disorders, Female, Humans, Interviews as Topic, Longitudinal Studies, Markov Chains, Psychology, Social Adjustment, Chi-Square Distribution, Linear Models, Diagnostic and Statistical Manual of Mental Disorders, Bulimia Nervosa, Young Adult
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