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Levinson CA, Osborn K, Hooper M, Vanzhula I, Ralph-Nearman C. Evidence-Based Assessments for Transdiagnostic Eating Disorder Symptoms: Guidelines for Current Use and Future Directions. Assessment 2024; 31:145-167. [PMID: 37997290 DOI: 10.1177/10731911231201150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
Eating disorders are severe and often chronic mental illnesses that are associated with high impairment and mortality rates. Recent estimates suggest that eating disorder prevalence rates are on the rise, indicating an increased need for accurate assessment and detection. The current review provides an overview of transdiagnostic eating disorder assessments, including interview, self-report, health and primary care screeners, and technology-based and objective assessments. We focused on assessments that are transdiagnostic in nature and exhibit high impact in the field. We provide recommendations for how these assessments should be used in research and clinical settings. We also discuss considerations that are crucial for assessment, including the use of a categorical versus dimensional diagnostic framework, assessment of eating disorders in related fields (i.e., anxiety and depression), and measurement-based care for eating disorders. Finally, we provide suggestions for future research, including the need for more research on short transdiagnostic screeners for use in health care settings, standardized assessments for ecological momentary assessment, development of state-based assessment of eating disorder symptoms, and consideration of assessment across multiple timescales.
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Affiliation(s)
| | - Kimberly Osborn
- University of Louisville, KY, USA
- Oklahoma State University, Stillwater, USA
| | - Madison Hooper
- University of Louisville, KY, USA
- Vanderbilt University, Nashville, TN, USA
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2
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Sharpe SL, Adams M, Smith EK, Urban B, Silverstein S. Inaccessibility of care and inequitable conceptions of suffering: a collective response to the construction of "terminal" anorexia nervosa. J Eat Disord 2023; 11:66. [PMID: 37131268 PMCID: PMC10152768 DOI: 10.1186/s40337-023-00791-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 04/21/2023] [Indexed: 05/04/2023] Open
Abstract
Informed by our lived experiences with eating disorders, our work providing direct support to communities underserved by existing healthcare structures, and our commitment to social justice, we are deeply troubled by several aspects of the proposed characteristics for "terminal" anorexia nervosa outlined by Gaudiani et al. in Journal of Eating Disorders (10:23, 2022). We have identified two substantial areas of concern in the proposed characteristics provided by Gaudiani et al. and the subsequent publication by Yager et al. (10:123, 2022). First, the original article and the subsequent publication fail to adequately address the widespread inaccessibility of eating disorder treatment, the lack of parameters for what constitutes "high quality care", and the prevalence of trauma experienced in treatment settings for those who do access treatment. Second, the characteristics proposed for "terminal" anorexia nervosa are constructed largely based on subjective and inconsistent valuations of suffering which build on and contribute to harmful and inaccurate eating disorder stereotypes. Overall, we believe these proposed characteristics in their current form stand to detract from, rather than assist, the ability of patients and providers to make informed, compassionate, and patient-centered decisions about safety and autonomy both for individuals with enduring eating disorders and for individuals with more recently diagnosed eating disorders.
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Affiliation(s)
- Sam L Sharpe
- Fighting Eating Disorders in Underrepresented Populations (FEDUP) Collective, 4400 North Congress Avenue Suite 100, West Palm Beach, FL, 33407, USA.
| | - Marissa Adams
- Fighting Eating Disorders in Underrepresented Populations (FEDUP) Collective, 4400 North Congress Avenue Suite 100, West Palm Beach, FL, 33407, USA
| | - Emil K Smith
- Fighting Eating Disorders in Underrepresented Populations (FEDUP) Collective, 4400 North Congress Avenue Suite 100, West Palm Beach, FL, 33407, USA
| | - Bek Urban
- Fighting Eating Disorders in Underrepresented Populations (FEDUP) Collective, 4400 North Congress Avenue Suite 100, West Palm Beach, FL, 33407, USA
| | - Scout Silverstein
- Fighting Eating Disorders in Underrepresented Populations (FEDUP) Collective, 4400 North Congress Avenue Suite 100, West Palm Beach, FL, 33407, USA
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Longo P, Toppino F, Martini M, Panero M, De Bacco C, Marzola E, Abbate-Daga G. Diagnostic Concordance between Research and Clinical-Based Assessments of Psychiatric Comorbidity in Anorexia Nervosa. J Clin Med 2022; 11:jcm11247419. [PMID: 36556034 PMCID: PMC9782669 DOI: 10.3390/jcm11247419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/09/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
The literature has reported poor concordance in the assessment of psychiatric conditions, and inhomogeneity in the prevalence of psychiatric comorbidities in Anorexia Nervosa (AN). We aimed to investigate concordance level between clinicians' and researchers' diagnoses of psychiatric comorbidity in AN and differences in eating and general psychopathology between patients with and without psychiatric comorbidity assessed by clinicians versus researchers. A clinical psychiatrist interviewed 122 patients with AN; then a researcher administered the Structured and Clinical Interview for DSM-5 (SCID-5). Participants completed the Eating Disorder Examination Questionnaire (EDE-Q), the State-Trait Anxiety Inventory (STAI), and the Beck Depression Inventory (BDI). The agreement between clinicians and researchers was poor for all diagnoses but obsessive-compulsive disorder and substance use disorder. Patients with comorbid disorders diagnosed by researchers reported more severe eating and general psychopathology than those without SCID-comorbidity. The differences between patients with and without comorbidities assessed by a clinician were smaller. Two approaches to psychiatry comorbidity assessment emerged: SCID-5 diagnoses yield a precise and rigorous assessment, while clinicians tend to consider some symptoms as secondary to the eating disorder rather than as part of another psychiatric condition, seeing the clinical picture as a whole. Overall, the study highlights the importance of carefully assessing comorbidity in AN.
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Mora F, Alvarez-Mon MA, Fernandez-Rojo S, Ortega MA, Felix-Alcantara MP, Morales-Gil I, Rodriguez-Quiroga A, Alvarez-Mon M, Quintero J. Psychosocial Factors in Adolescence and Risk of Development of Eating Disorders. Nutrients 2022; 14:nu14071481. [PMID: 35406094 PMCID: PMC9002868 DOI: 10.3390/nu14071481] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/08/2022] [Accepted: 03/28/2022] [Indexed: 02/01/2023] Open
Abstract
Background: current findings in the etiopathogenesis of eating disorders (ED) do not allow the formulation of a unique causal model. Currently, the main hypotheses about the etiopathogenesis are based on a multifactorial approach, considering both genetic and environmental factors. The aim of this study is to analyze the relationship between sociodemographic and behavioral factors, as well as self-esteem, in students of the first cycle of middle school and the probability of belonging to the risk group of eating disorders (ED) measured through the EAT-26 scale. Methods: The study target population consists of students of the first cycle of middle school. The instruments applied to the population consisted in: (1) a survey of sociodemographic data and behavioral variables; (2) Rosenberg’s self-esteem test; and (3) EAT Test (Eating Attitudes Test 26). Results: Of a total of 656 students belonging to eight educational centers in Madrid who were offered to participate in the study, 88.6% (n = 579) answered the whole questionnaire. The mean age of the participants was 13.7 years old. Of the participating adolescents, 57.3% were male and the remaining 42.7% (n = 260) were female. A significant relationship was observed between self-esteem and belonging to an ED risk group, with an OR = 0.910 (CI 95% 0.878−0.943). Hence, each one-point increase on the self-esteem dimension decreased the risk of belonging to an ED risk group by 9.5%. In the variables considered in the area of dysfunctional feeding patterns, the variables ‘number of meals’ (p < 0.01), ‘dieting’ (p < 0.01), and ‘drug consumption to lose weight’ (p < 0.01) were found to be related to the risk of belonging to the ED group. Conclusions: The results obtained in our research can help to establish explanatory models that include the understanding of the interaction of the different factors that influence the appearance and development of EDs. Therefore, these should be taken into consideration when developing ED preventive programs.
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Affiliation(s)
- Fernando Mora
- Department of Psychiatry and Mental Health, Hospital Universitario Infanta Leonor, 28031 Madrid, Spain; (F.M.); (S.F.-R.); (M.P.F.-A.); (A.R.-Q.); (J.Q.)
- Department of Legal Medicine and Psychiatry, Complutense University, 28040 Madrid, Spain;
| | - Miguel A. Alvarez-Mon
- Department of Psychiatry and Mental Health, Hospital Universitario Infanta Leonor, 28031 Madrid, Spain; (F.M.); (S.F.-R.); (M.P.F.-A.); (A.R.-Q.); (J.Q.)
- Department of Medicine and Medical Specialities, University of Alcala, 28801 Alcala de Henares, Spain;
- Correspondence:
| | - Sonia Fernandez-Rojo
- Department of Psychiatry and Mental Health, Hospital Universitario Infanta Leonor, 28031 Madrid, Spain; (F.M.); (S.F.-R.); (M.P.F.-A.); (A.R.-Q.); (J.Q.)
| | - Miguel A. Ortega
- Department of Legal Medicine and Psychiatry, Complutense University, 28040 Madrid, Spain;
| | - Miriam P. Felix-Alcantara
- Department of Psychiatry and Mental Health, Hospital Universitario Infanta Leonor, 28031 Madrid, Spain; (F.M.); (S.F.-R.); (M.P.F.-A.); (A.R.-Q.); (J.Q.)
| | | | - Alberto Rodriguez-Quiroga
- Department of Psychiatry and Mental Health, Hospital Universitario Infanta Leonor, 28031 Madrid, Spain; (F.M.); (S.F.-R.); (M.P.F.-A.); (A.R.-Q.); (J.Q.)
| | - Melchor Alvarez-Mon
- Department of Medicine and Medical Specialities, University of Alcala, 28801 Alcala de Henares, Spain;
| | - Javier Quintero
- Department of Psychiatry and Mental Health, Hospital Universitario Infanta Leonor, 28031 Madrid, Spain; (F.M.); (S.F.-R.); (M.P.F.-A.); (A.R.-Q.); (J.Q.)
- Department of Legal Medicine and Psychiatry, Complutense University, 28040 Madrid, Spain;
- Psikids, 28002 Madrid, Spain;
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Harrop EN, Mensinger JL, Moore M, Lindhorst T. Restrictive eating disorders in higher weight persons: A systematic review of atypical anorexia nervosa prevalence and consecutive admission literature. Int J Eat Disord 2021; 54:1328-1357. [PMID: 33864277 PMCID: PMC9035356 DOI: 10.1002/eat.23519] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 04/08/2021] [Accepted: 04/08/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Currently, there is debate in the eating disorders field regarding how to define atypical anorexia (AAN), how prevalent it is in community and clinical settings, and how AAN rates compare with low-weight AN. This systematic review assesses AAN literature from 2007 to 2020, to investigate: (a) the demographic characteristics of AAN studies, (b) the prevalence of AAN compared with AN, (c) the range of operational definitions of AAN and the implications of these definitions, and (d) the proportion of patients with AAN and AN represented in consecutive admission and referral samples. METHOD PsychINFO, CINAHL, PubMed, Greylit.org, and ProQuest databases were searched according to methods for Preferred Reporting Items for Systematic Reviews and Meta-Analyses systematic reviews, yielding 3,184 potential articles. Seventy-five eligible studies were coded for sixty-one variables. RESULTS Clinical samples predominantly included younger, female, white samples with limited diversity. In epidemiological designs, AAN was typically as common or more common than AN, and AAN rates varied significantly based on the population studied and operational definitions. In consecutive clinical samples, AAN was frequently less represented. DISCUSSION Although AAN appears to occur more frequently than AN in communities, fewer patients with AAN are being referred and admitted to eating disorder specific care, particularly in the United States. Given the significant medical and psychosocial consequences of AAN, and the importance of early intervention, this represents a crucial treatment gap. Additionally, results suggest the need for fine-tuning diagnostic definitions, greater diversity in AAN studies, and increased screening and referral for this vulnerable population.
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Affiliation(s)
- Erin N. Harrop
- Graduate School of Social Work, University of Denver, Denver, Colorado,School of Social Work, University of Washington, Seattle, Washington
| | | | - Megan Moore
- School of Social Work, University of Washington, Seattle, Washington
| | - Taryn Lindhorst
- School of Social Work, University of Washington, Seattle, Washington
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6
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Estour B, Marouani N, Sigaud T, Lang F, Fakra E, Ling Y, Diamondé A, Minnion JS, Galusca B, Germain N. Differentiating constitutional thinness from anorexia nervosa in DSM 5 era. Psychoneuroendocrinology 2017; 84:94-100. [PMID: 28692876 DOI: 10.1016/j.psyneuen.2017.06.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 06/21/2017] [Accepted: 06/21/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Constitutional thinness (CT) is an underweight state characterized by normal menstruations and no change in feeding behaviour. Thinness is the only resemblance between Anorexia Nervosa (AN) and CT. Removal of amenorrhea from the new DSM 5 definition of AN might result in misdiagnosis between these two populations. The objective of this study was to compare CT, AN and Control subjects in terms of biological, anthropometric, and psychological markers in order to better distinguish AN from CT subjects. MATERIALS AND METHODS Body composition, nutritional markers, pituitary hormones, bone markers and psychological scores were evaluated in three groups of young women: fifty-six CT, forty restrictive-type AN and fifty-four Control subjects. For every marker, a receiver Operator Characteristics (ROC) curve was calculated to evaluate the accuracy of differentiation between AN and CT groups. RESULTS For most studied parameters, CT subjects were similar to Controls but dramatically different from AN subjects. DEBQ Restrained Eating subscale score was identified by ROC data analysis as the only psychological parameter tested to successfully differentiate AN from CT. Free-T3 and Leptin were shown to be powerful markers to differentiate AN and CT populations as they were highly specific and sensitive ones. CONCLUSION The exclusive use of psychological testing criteria is not always sufficient to differentiate AN and CT patients. Minimally, additional testing of Free T3 levels, which is cheap and widely accessible for general practitioners, should be completed to avoid misdiagnosis which could result in the implementation of ineffective treatment plans and social stigmatization for CT women.
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Affiliation(s)
- Bruno Estour
- Department of Endocrinology, Diabetes, Metabolism and Eating Disorders, University hospital of Saint-Etienne, Saint-Etienne, France; Eating Disorders, Addictions & Extreme Bodyweight Research Group EA 7423, Jean Monnet university, Saint-Etienne, France; Reference Center for Eating Disorders, University hospital of Saint-Etienne, Saint-Etienne, France
| | - Nesrine Marouani
- Department of Endocrinology, Diabetes, Metabolism and Eating Disorders, University hospital of Saint-Etienne, Saint-Etienne, France
| | - Torrance Sigaud
- Eating Disorders, Addictions & Extreme Bodyweight Research Group EA 7423, Jean Monnet university, Saint-Etienne, France; Reference Center for Eating Disorders, University hospital of Saint-Etienne, Saint-Etienne, France; Department of Psychiatry, University hospital of Saint-Etienne, Saint-Etienne, France
| | - François Lang
- Eating Disorders, Addictions & Extreme Bodyweight Research Group EA 7423, Jean Monnet university, Saint-Etienne, France; Reference Center for Eating Disorders, University hospital of Saint-Etienne, Saint-Etienne, France; Department of Psychiatry, University hospital of Saint-Etienne, Saint-Etienne, France
| | - Eric Fakra
- Eating Disorders, Addictions & Extreme Bodyweight Research Group EA 7423, Jean Monnet university, Saint-Etienne, France; Department of Psychiatry, University hospital of Saint-Etienne, Saint-Etienne, France
| | - Yiin Ling
- Eating Disorders, Addictions & Extreme Bodyweight Research Group EA 7423, Jean Monnet university, Saint-Etienne, France
| | - Aurélie Diamondé
- Eating Disorders, Addictions & Extreme Bodyweight Research Group EA 7423, Jean Monnet university, Saint-Etienne, France
| | - James S Minnion
- Investigative medicine, Imperial College London, United Kingdom
| | - Bogdan Galusca
- Department of Endocrinology, Diabetes, Metabolism and Eating Disorders, University hospital of Saint-Etienne, Saint-Etienne, France; Eating Disorders, Addictions & Extreme Bodyweight Research Group EA 7423, Jean Monnet university, Saint-Etienne, France; Reference Center for Eating Disorders, University hospital of Saint-Etienne, Saint-Etienne, France
| | - Natacha Germain
- Department of Endocrinology, Diabetes, Metabolism and Eating Disorders, University hospital of Saint-Etienne, Saint-Etienne, France; Eating Disorders, Addictions & Extreme Bodyweight Research Group EA 7423, Jean Monnet university, Saint-Etienne, France; Reference Center for Eating Disorders, University hospital of Saint-Etienne, Saint-Etienne, France.
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7
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Thomas JJ, Eddy KT, Murray HB, Tromp MDP, Hartmann AS, Stone MT, Levendusky PG, Becker AE. The impact of revised DSM-5 criteria on the relative distribution and inter-rater reliability of eating disorder diagnoses in a residential treatment setting. Psychiatry Res 2015; 229:517-23. [PMID: 26160205 DOI: 10.1016/j.psychres.2015.06.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 06/05/2015] [Accepted: 06/25/2015] [Indexed: 11/18/2022]
Abstract
This study evaluated the relative distribution and inter-rater reliability of revised DSM-5 criteria for eating disorders in a residential treatment program. Consecutive adolescent and young adult females (N=150) admitted to a residential eating disorder treatment facility were assigned both DSM-IV and DSM-5 diagnoses by a clinician (n=14) via routine clinical interview and a research assessor (n=4) via structured interview. We compared the frequency of diagnostic assignments under each taxonomy and by type of assessor. We evaluated concordance between clinician and researcher assignment through inter-rater reliability kappa and percent agreement. Significantly fewer patients received either clinician or researcher diagnoses of a residual eating disorder under DSM-5 (clinician-12.0%; researcher-31.3%) versus DSM-IV (clinician-28.7%; researcher-59.3%), with the majority of reassigned DSM-IV residual cases reclassified as DSM-5 anorexia nervosa. Researcher and clinician diagnoses showed moderate inter-rater reliability under DSM-IV (κ=.48) and DSM-5 (κ=.57), though agreement for specific DSM-5 other specified feeding or eating disorder (OSFED) presentations was poor (κ=.05). DSM-5 revisions were associated with significantly less frequent residual eating disorder diagnoses, but not with reduced inter-rater reliability. Findings support specific dimensions of clinical utility for revised DSM-5 criteria for eating disorders.
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Affiliation(s)
- Jennifer J Thomas
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston , MA, USA.
| | - Kamryn T Eddy
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston , MA, USA
| | - Helen B Murray
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA, USA
| | - Marilou D P Tromp
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA, USA
| | - Andrea S Hartmann
- Institute of Psychology, University of Osnabrück, Neuer Graben, 49074 Osnabrück, Germany
| | - Melissa T Stone
- Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston , MA, USA
| | - Philip G Levendusky
- Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston , MA, USA; Klarman Eating Disorders Center, McLean Hospital, 115 Mill Street, Belmont, MA, USA
| | - Anne E Becker
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston , MA, USA; Department of Global Health & Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, USA
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8
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Sysko R, Glasofer DR, Hildebrandt T, Klimek P, Mitchell JE, Berg KC, Peterson CB, Wonderlich SA, Walsh BT. The eating disorder assessment for DSM-5 (EDA-5): Development and validation of a structured interview for feeding and eating disorders. Int J Eat Disord 2015; 48:452-63. [PMID: 25639562 PMCID: PMC4721239 DOI: 10.1002/eat.22388] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 12/22/2014] [Accepted: 01/02/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Existing measures for DSM-IV eating disorder diagnoses have notable limitations, and there are important differences between DSM-IV and DSM-5 feeding and eating disorders. This study developed and validated a new semistructured interview, the Eating Disorders Assessment for DSM-5 (EDA-5). METHOD Two studies evaluated the utility of the EDA-5. Study 1 compared the diagnostic validity of the EDA-5 with the Eating Disorder Examination (EDE) and evaluated the test-retest reliability of the new measure. Study 2 compared the diagnostic validity of an EDA-5 electronic application ("App") with clinician interview and self-reported assessments. RESULTS In Study 1, the kappa for EDE and EDA-5 eating disorder diagnoses was 0.74 across all diagnoses (n = 64), with a range of κ = 0.65 for other specified feeding or eating disorder/unspecified feeding or eating disorder to κ = 0.90 for binge eating disorder. The EDA-5 test-retest kappa coefficient was 0.87 across diagnoses. For Study 2, clinical interview versus App conditions revealed a kappa of 0.83 for all eating disorder diagnoses (n = 71). Across individual diagnostic categories, kappas ranged from 0.56 for other specified feeding or eating disorder/unspecified feeding or eating disorder to 0.94 for BN. DISCUSSION High rates of agreement were found between diagnoses by EDA-5 and the EDE, and EDA-5 and clinical interviews. Because this study supports the validity of the EDA-5 to generate DSM-5 eating disorders and the reliability of these diagnoses, the EDA-5 may be an option for the assessment of anorexia nervosa, bulimia nervosa, and binge eating disorder. Additional research is needed to evaluate the utility of the EDA-5 in assessing DSM-5 feeding disorders.
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Affiliation(s)
- Robyn Sysko
- Division of Clinical Therapeutics, New York State Psychiatric Institute, New York, NY,Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY
| | - Deborah R. Glasofer
- Division of Clinical Therapeutics, New York State Psychiatric Institute, New York, NY,Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY
| | - Tom Hildebrandt
- Eating and Weight Disorders Program, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Patrycja Klimek
- Eating and Weight Disorders Program, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | - James E. Mitchell
- University of North Dakota School of Medicine and Health Sciences, Fargo, ND,Neuropsychiatric Research Institute, Fargo, ND
| | - Kelly C. Berg
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota
| | - Carol B. Peterson
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota
| | - Stephen A. Wonderlich
- University of North Dakota School of Medicine and Health Sciences, Fargo, ND,Neuropsychiatric Research Institute, Fargo, ND
| | - B. Timothy Walsh
- Division of Clinical Therapeutics, New York State Psychiatric Institute, New York, NY,Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY
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9
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Thomas JJ, Eddy KT, Ruscio J, Ng KL, Casale KE, Becker AE, Lee S. Do recognizable lifetime eating disorder phenotypes naturally occur in a culturally asian population? A combined latent profile and taxometric approach. EUROPEAN EATING DISORDERS REVIEW 2015; 23:199-209. [PMID: 25787700 DOI: 10.1002/erv.2357] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 02/17/2015] [Accepted: 02/22/2015] [Indexed: 11/12/2022]
Abstract
BACKGROUND We examined whether empirically derived eating disorder (ED) categories in Hong Kong Chinese patients (N = 454) would be consistent with recognizable lifetime ED phenotypes derived from latent structure models of European and American samples. METHOD We performed latent profile analysis (LPA) using indicator variables from data collected during routine assessment, and then applied taxometric analysis to determine whether latent classes were qualitatively versus quantitatively distinct. RESULTS Latent profile analysis identified four classes: (i) binge/purge (47%); (ii) non-fat-phobic low-weight (34%); (iii) fat-phobic low-weight (12%); and (iv) overweight disordered eating (6%). Taxometric analysis identified qualitative (categorical) distinctions between the binge/purge and non-fat-phobic low-weight classes, and also between the fat-phobic and non-fat-phobic low-weight classes. Distinctions between the fat-phobic low-weight and binge/purge classes were indeterminate. CONCLUSION Empirically derived categories in Hong Kong showed recognizable correspondence with recognizable lifetime ED phenotypes. Although taxometric findings support two distinct classes of low weight EDs, LPA findings also support heterogeneity among non-fat-phobic individuals.
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Affiliation(s)
- Jennifer J Thomas
- Department of Psychiatry, Harvard Medical School, MA, USA; Eating Disorders Clinical and Research Program, Massachusetts General Hospital, MA, USA
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10
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Evaluating reliable and clinically significant change in eating disorders: comparisons to changes in DSM-IV diagnoses. Psychiatry Res 2014; 216:248-54. [PMID: 24582504 DOI: 10.1016/j.psychres.2014.02.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 01/31/2014] [Accepted: 02/05/2014] [Indexed: 11/20/2022]
Abstract
Assessing clinically meaningful change is valuable for treatment planning, monitoring course of illness and evaluating outcome. Although DSM eating disorder (ED) diagnoses have been criticized for poor clinical utility, instability, and uncertainty, remission/change of diagnosis is often the standard for evaluating outcome. We tested the validity of the clinically significant reliable change index (CS/RCI) compared to change in DSM-IV ED-diagnoses. We investigated if CS/RCI was concordant to diagnostic change and compared explained variance on measures at follow-up. Using a database for specialized ED treatment in Sweden the sample contained 1042 female patients (246 adolescents/796 adults). CS/RCI was calculated for the Clinical Impairment Assessment (CIA) and the Eating Disorder Examination Questionnaire (EDE-Q). CS/RCI explained more variance in gain scores for psychopathology measures than diagnostic change (DSM-IV). Average agreement between diagnostic change and CS/RCI was 62% and 60% for CIA and EDE-Q, respectively. Diagnostic change always resulted in more positive outcome than CS/RCI. Together with clinical judgment, CS/RCI is a valuable method for determining clinically significant changes in clinical practice and research. It is economically sound and results are easily interpreted and communicated to patients.
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11
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Thomas JJ, Koh KA, Eddy KT, Hartmann AS, Murray HB, Gorman MJ, Sogg S, Becker AE. Do DSM-5 eating disorder criteria overpathologize normative eating patterns among individuals with obesity? J Obes 2014; 2014:320803. [PMID: 25057413 PMCID: PMC4098982 DOI: 10.1155/2014/320803] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Accepted: 05/26/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND DSM-5 revisions have been criticized in the popular press for overpathologizing normative eating patterns-particularly among individuals with obesity. To evaluate the evidence for this and other DSM-5 critiques, we compared the point prevalence and interrater reliability of DSM-IV versus DSM-5 eating disorders (EDs) among adults seeking weight-loss treatment. METHOD Clinicians (n = 2) assigned DSM-IV and DSM-5 ED diagnoses to 100 participants via routine clinical interview. Research assessors (n = 3) independently conferred ED diagnoses via Structured Clinical Interview for DSM-IV and a DSM-5 checklist. RESULTS Research assessors diagnosed a similar proportion of participants with EDs under DSM-IV (29%) versus DSM-5 (32%). DSM-5 research diagnoses included binge eating disorder (9%), bulimia nervosa (2%), subthreshold binge eating disorder (5%), subthreshold bulimia nervosa (2%), purging disorder (1%), night eating syndrome (6%), and other (7%). Interrater reliability between clinicians and research assessors was "substantial" for both DSM-IV (κ = 0.64, 84% agreement) and DSM-5 (κ = 0.63, 83% agreement). CONCLUSION DSM-5 ED criteria can be reliably applied in an obesity treatment setting and appear to yield an overall ED point prevalence comparable to DSM-IV.
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Affiliation(s)
- Jennifer J. Thomas
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02114, USA
- *Jennifer J. Thomas:
| | - Katherine A. Koh
- Department of Psychiatry, Harvard Medical School, Boston, MA 02114, USA
| | - Kamryn T. Eddy
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02114, USA
| | - Andrea S. Hartmann
- Institute for Psychology, University of Osnabrück, 49074 Osnabrück, Germany
| | - Helen B. Murray
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Mark J. Gorman
- Department of Psychiatry, Harvard Medical School, Boston, MA 02114, USA
- Massachusetts General Hospital Weight Center, Boston, MA 02114, USA
| | - Stephanie Sogg
- Department of Psychiatry, Harvard Medical School, Boston, MA 02114, USA
- Massachusetts General Hospital Weight Center, Boston, MA 02114, USA
| | - Anne E. Becker
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02114, USA
- Department of Global Health & Social Medicine, Harvard Medical School, Boston, MA 02115, USA
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Kanakam N, Krug I, Raoult C, Collier D, Treasure J. Social and Emotional Processing as a Behavioural Endophenotype in Eating Disorders: A Pilot Investigation in Twins. EUROPEAN EATING DISORDERS REVIEW 2013; 21:294-307. [DOI: 10.1002/erv.2232] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
| | - Isabel Krug
- Eating Disorders Research Unit; Guys Hospital; London; UK
| | | | - David Collier
- Eating Disorders Research Unit; Guys Hospital; London; UK
| | - Janet Treasure
- Eating Disorders Research Unit; Guys Hospital; London; UK
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Abstract
Current classification of eating disorders is failing to classify most clinical presentations; ignores continuities between child, adolescent and adult manifestations; and requires frequent changes of diagnosis to accommodate the natural course of these disorders. The classification is divorced from clinical practice, and investigators of clinical trials have felt compelled to introduce unsystematic modifications. Classification of feeding and eating disorders in ICD-11 requires substantial changes to remediate the shortcomings. We review evidence on the developmental and cross-cultural differences and continuities, course and distinctive features of feeding and eating disorders. We make the following recommendations: a) feeding and eating disorders should be merged into a single grouping with categories applicable across age groups; b) the category of anorexia nervosa should be broadened through dropping the requirement for amenorrhoea, extending the weight criterion to any significant underweight, and extending the cognitive criterion to include developmentally and culturally relevant presentations; c) a severity qualifier "with dangerously low body weight" should distinguish the severe cases of anorexia nervosa that carry the riskiest prognosis; d) bulimia nervosa should be extended to include subjective binge eating; e) binge eating disorder should be included as a specific category defined by subjective or objective binge eating in the absence of regular compensatory behaviour; f) combined eating disorder should classify subjects who sequentially or concurrently fulfil criteria for both anorexia and bulimia nervosa; g) avoidant/restrictive food intake disorder should classify restricted food intake in children or adults that is not accompanied by body weight and shape related psychopathology; h) a uniform minimum duration criterion of four weeks should apply.
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14
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Sysko R, Roberto CA, Barnes RD, Grilo CM, Attia E, Walsh BT. Test-retest reliability of the proposed DSM-5 eating disorder diagnostic criteria. Psychiatry Res 2012; 196:302-8. [PMID: 22401974 PMCID: PMC3361586 DOI: 10.1016/j.psychres.2011.12.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 12/06/2011] [Accepted: 12/12/2011] [Indexed: 02/07/2023]
Abstract
The proposed DSM-5 classification scheme for eating disorders includes both major and minor changes to the existing DSM-IV diagnostic criteria. It is not known what effect these modifications will have on the ability to make reliable diagnoses. Two studies were conducted to evaluate the short-term test-retest reliability of the proposed DSM-5 eating disorder diagnoses: anorexia nervosa, bulimia nervosa, binge eating disorder, and feeding and eating conditions not elsewhere classified. Participants completed two independent telephone interviews with research assessors (n=70 Study 1; n=55 Study 2). Fair to substantial agreements (κ=0.80 and 0.54) were observed across eating disorder diagnoses in Study 1 and Study 2, respectively. Acceptable rates of agreement were identified for the individual eating disorder diagnoses, including DSM-5 anorexia nervosa (κ's of 0.81 to 0.97), bulimia nervosa (κ=0.84), binge eating disorder (κ's of 0.75 and 0.61), and feeding and eating disorders not elsewhere classified (κ's of 0.70 and 0.46). Further, improved short-term test-retest reliability was noted when using the DSM-5, in comparison to DSM-IV, criteria for binge eating disorder. Thus, these studies found that trained interviewers can reliably diagnose eating disorders using the proposed DSM-5 criteria; however, additional data from general practice settings and community samples are needed.
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Affiliation(s)
- Robyn Sysko
- New York State Psychiatric Institute, New York, NY, USA.
| | - Christina A. Roberto
- Division of Clinical Therapeutics, New York State Psychiatric Institute and the Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA,Department of Psychology, Yale University, New Haven, CT, USA,School of Epidemiology & Public Health, Yale University, New Haven, CT, USA
| | | | - Carlos M. Grilo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA,Department of Psychology, Yale University, New Haven, CT, USA
| | - Evelyn Attia
- Division of Clinical Therapeutics, New York State Psychiatric Institute and the Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | - B. Timothy Walsh
- Division of Clinical Therapeutics, New York State Psychiatric Institute and the Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA
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15
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Peterson CB, Crow SJ, Swanson SA, Crosby RD, Wonderlich SA, Mitchell JE, Agras WS, Halmi KA. Examining the stability of DSM-IV and empirically derived eating disorder classification: implications for DSM-5. J Consult Clin Psychol 2011; 79:777-83. [PMID: 22040286 DOI: 10.1037/a0025941] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The purpose of this investigation was to derive an empirical classification of eating disorder symptoms in a heterogeneous eating disorder sample using latent class analysis (LCA) and to examine the longitudinal stability of these latent classes (LCs) and the stability of DSM-IV eating disorder (ED) diagnoses. METHOD A total of 429 females with ED symptoms were assessed using the Eating Disorder Examination every 6 months for 2 years. LCA was used to derive empirical classification at baseline. Latent transition analysis (LTA) was used to examine the longitudinal stability of LCs, and Markov modeling procedures were used to examine DSM-IV ED diagnoses over all the time points. RESULTS LCA yielded a 3-class solution: binge eating and purging, binge eating only, and low body mass index. LTA indicated that these LCs showed greater stability over 2 years than DSM-IV diagnoses with the probability of remaining in the same class ranging from 0.69 to 0.91 for LCs and from 0.40 to 0.75 for DSM-IV diagnoses. Transition patterns also revealed more stability for LCs with only 21% changing classes compared with 63% of the DSM-IV diagnostic categories. CONCLUSION Empirically derived classes of ED symptoms showed greater longitudinal stability than DSM-IV diagnoses over a 2-year time period, suggesting that modifying the criteria to be consistent with empirically based classification (e.g., reducing frequency requirements of binge eating and purging) may reduce ED diagnostic crossover in DSM-5.
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Affiliation(s)
- Carol B Peterson
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN 55454-1495, USA.
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Tchanturia K, Harrison A, Davies H, Roberts M, Oldershaw A, Nakazato M, Stahl D, Morris R, Schmidt U, Treasure J. Cognitive flexibility and clinical severity in eating disorders. PLoS One 2011; 6:e20462. [PMID: 21698277 PMCID: PMC3115939 DOI: 10.1371/journal.pone.0020462] [Citation(s) in RCA: 154] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2011] [Accepted: 04/25/2011] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES The aim of this study was to explore cognitive flexibility in a large dataset of people with Eating Disorders and Healthy Controls (HC) and to see how patient characteristics (body mass index [BMI] and length of illness) are related to this thinking style. METHODS A dataset was constructed from our previous studies using a conceptual shift test--the Brixton Spatial Anticipation Test. 601 participants were included, 215 patients with Anorexia Nervosa (AN) (96 inpatients; 119 outpatients), 69 patients with Bulimia Nervosa (BN), 29 Eating Disorder Not Otherwise Specified (EDNOS), 72 in long-term recovery from AN (Rec AN) and a comparison group of 216 HC. RESULTS The AN and EDNOS groups had significantly more errors than the other groups on the Brixton Test. In comparison to the HC group, the effect size decrement was large for AN patients receiving inpatient treatment and moderate for AN outpatients. CONCLUSIONS These findings confirm that patients with AN have poor cognitive flexibility. Severity of illness measured by length of illness does not fully explain the lack of flexibility and supports the trait nature of inflexibility in people with AN.
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Affiliation(s)
- Kate Tchanturia
- Institute of Psychiatry, Psychological Medicine, King's College London, London, United Kingdom.
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