The Validity and Clinical Utility of Purging Disorder

Department of Psychology, Florida State University, 1107 W. Call St., Tallahassee, Florida 32306-4301, USA.
International Journal of Eating Disorders (Impact Factor: 3.13). 12/2009; 42(8):706-19. DOI: 10.1002/eat.20718
Source: PubMed


To review evidence of the validity and clinical utility of Purging Disorder and examine options for the Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-V).
Articles were identified by computerized and manual searches and reviewed to address five questions about Purging Disorder: Is there "ample" literature? Is the syndrome clearly defined? Can it be measured and diagnosed reliably? Can it be differentiated from other eating disorders? Is there evidence of syndrome validity?
Although empirical classification and concurrent validity studies provide emerging support for the distinctiveness of Purging Disorder, questions remain about definition, diagnostic reliability in clinical settings, and clinical utility (i.e., prognostic validity).
We discuss strengths and weaknesses associated with various options for the status of Purging Disorder in the DSM-V ranging from making no changes from DSM-IV to designating Purging Disorder a diagnosis on equal footing with Anorexia Nervosa and Bulimia Nervosa.

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Available from: Ruth Striegel Weissman, Aug 21, 2015
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    • "In recent years, there has been considerable interest in a second variant of BN, namely, disorders characterized by the regular use of purging behaviors in the absence of regular episodes of binge eating. The term “purging disorder” has been introduced to refer to disorders of this kind and considerable evidence to support the clinical significance of these disorders has now been amassed [52,53]. Hence, purging disorder is included as an exemplar of the DSM-5 “Feeding or Eating Disorder Not Elsewhere Classified” category (bottom right of Table 1). "
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    ABSTRACT: Proposed changes to the classification of bulimic-type eating disorders in the lead up to the publication of DSM-5 are reviewed. Several of the proposed changes, including according formal diagnostic status to binge eating disorder (BED), removing the separation of bulimia nervosa (BN) into purging and non-purging subtypes, and reducing the binge frequency threshold from twice per week to once per week for both BN and (BED), have considerable empirical evidence to support them and will likely have the effect of facilitating clinical practice, improving access to care, improving public and professional awareness and understanding of these disorders and stimulating the additional research needed to address at least some problematic issues. However, the omission of any reference to variants of BN characterized by subjective, but not objective, binge eating episodes, and to the undue influence of weight or shape on self-evaluation or similar cognitive criterion in relation to the diagnosis of BED, is regrettable, given their potential to inform clinical and research practice and given that there is considerable evidence to support specific reference to these distinctions. Other aspects of the proposed criteria, such as retention of behavioral indicators of impaired control associated with binge eating and the presence of marked distress regarding binge eating among the diagnostic for BED, appear anomalous in that there is little or no evidence to support their validity or clinical utility. It is hoped that these issues will be addressed in final phase of the DSM-5 development process.
    Full-text · Article · Aug 2013 · International Journal of Eating Disorders
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    • "PD does not appear to differ in remission rates compared to other diagnoses [20-22], and studies of the persistence of symptoms present a varied picture [21-23]. Most work has compared PD to BN, and a few to AN and BED, but no comparisons have been made to other EDNOS categories, which is imperative if PD is to be considered meaningfully different from these, and expected to emerge in the future as a distinct diagnosis of its own [24]. "
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    ABSTRACT: Background DSM-IV eating disorder (ED) diagnoses have been criticized for lack of clinical utility, diagnostic instability, and over-inclusiveness of the residual category “ED not otherwise specified” (EDNOS). Revisions made in DSM-5 attempt to generate a more scientifically valid and clinically relevant system of ED classification. The aim with the present study was to examine clinical characteristics and distinctiveness of the new DSM-5 ED diagnoses, especially concerning purging disorder (PD). Methods Using a large naturalistic Swedish ED database, 2233 adult women were diagnosed using DSM-5. Initial and 1-year follow-up psychopathology data were analyzed. Measures included the Eating Disorder Examination Questionnaire, Structural Eating Disorder Interview, Clinical Impairment Assessment, Structural Analysis of Social Behavior, Comprehensive Psychiatric Rating Scale, and Structured Clinical Interview for DSM-IV Axis I Disorders. Results Few meaningful differences emerged between anorexia nervosa binge/purge subtype (ANB/P), PD, and bulimia nervosa (BN). Unspecified Feeding and Eating Disorders (UFED) showed significantly less severity compared to other groups. Conclusions PD does not appear to constitute a distinct diagnosis, the distinction between atypical AN and PD requires clarification, and minimum inclusion criteria for UFED are needed. Further sub-classification is unlikely to improve clinical utility. Instead, better delineation of commonalities is important.
    Full-text · Article · Jul 2013 · Journal of Eating Disorders
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    • "3. Binge eating behavior may be associated with impulsivity [92], considered one of the diagnostic requirements of ADHD, as well as with specific elements of impulsivity, including the urgency element [93], and the need for immediate gratification [90]. "
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    ABSTRACT: Childhood obesity is on the rise in both industrialized and developing countries. The investigation of the psychosocial aspects of childhood obesity has been the focus of long- standing theoretical and empirical endeavor. Overweight in children and adolescents is associated with a host of psychological and social problems such as reduced school and social performance, less favorable quality of life, societal victimization and peer teasing, lower self-and body-esteem, and neuropsychological dysfunctioning. Whereas community samples of obese youngsters usually do not show elevated psychopathology, clinically-referred overweight children show elevated depression, anxiety, behavior problems, attention deficit hyperactivity disorder and disordered eating. Parents’ perceptions of their child’s overweight highly influence the well-being of obese children and the way in which they perceive themselves. The present review paper aims to broaden the scope of knowledge of clinicians about several important psychosocial and familial dimensions of childhood obesity: the psychosocial functioning, self and body esteem and psychopathology of overweight youngsters, the influence of children’s perceptions of overweight, including those of the obese children themselves on their well being, and the influence of parental attitudes about weight and eating on the psychological condition of the obese child.
    Full-text · Article · Feb 2013 · Journal of Eating Disorders
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