Clarifying criteria for cognitive symptoms for eating disorders in DSM-V

Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts 02115, USA.
International Journal of Eating Disorders (Impact Factor: 3.13). 11/2009; 42(7):611-9. DOI: 10.1002/eat.20723
Source: PubMed


This article reviews literature relevant to challenges in clinical ascertainment of cognitively-based diagnostic criteria of anorexia nervosa (AN) and bulimia nervosa (BN) to examine whether revision might enhance their clinical utility.
We performed a systematic literature search to identify publications relevant to clinical evaluation of cognitive symptoms of AN and BN.
The literature supports several reasons that individuals with an eating disorder may not endorse cognitive symptoms, despite their presence. These include limited insight, minimization, or denial, as well as intentional concealment related to perceived stigma, social desirability, or investment in maintaining behavioral symptoms. We also identified reasons that the word "refusal" in AN criterion A may render its application problematic.
We conclude that specific guidance for ascertainment of cognitive signs for AN and BN in the absence of patient disclosure or endorsement, longitudinal evaluation, and/or collateral data may improve clinical utility of these diagnostic criteria.

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    • "However, it remains unknown whether prospectively applying DSM-5 criteria will yield similar reductions in the comparative frequency of residual presentations. Whereas revised diagnostic criteria for DSM-5 AN allow clinicians to infer fear of weight gain from collateral history, longitudinal clinical course, or observed behavior, the assessment of cognitive eating disorder symptoms still relies primarily on self-report (Becker et al., 2009). For this reason, symptom ascertainment remains especially challenging in youth due to their less well-developed verbal and abstracting abilities, which may preclude them from endorsing complex phenomena such as overvaluation of shape and weight. "
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    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. Copyright © 2015. Published by Elsevier Ireland Ltd.
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    • "normative and disordered eating behaviours is needed . Finally , alternative diagnostic criteria have been suggested to minimise the number of individuals who fall into the EDNOS group ( Sysko & Walsh , 2011b ) . Some of these alternative diagnostic criteria proposals are con - servative , with limited changes to the existing diagnostic criteria ( Becker et al . , 2009 ) , whereas others are more liberal with changes to criteria . Future researchers may consider pitting sets of diagnostic criteria ( or diagnostic models ) against one another to determine which diagnostic model is the best fit in categorising eating disorder pathology of patients ."
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    ABSTRACT: The purpose of this study was to use responses to the self-report Eating Disorders Questionnaire (EDE-Q) to compare the proportion of individuals identified as having eating disorder pathology using the Diagnostic and statistical manual of mental disorders, fourth edition, text revision (DSM-IV-TR) criteria versus DSM-5 criteria. An ethnically diverse sample of college students (n = 2430; 56% White; 64% female) from three US universities completed an online survey that included the EDE-Q and psychological measurements (i.e. depression and anxiety severity). Diagnostic algorithms generated from DSM-IV-TR and DSM-5 criteria were applied to EDE-Q responses. DSM-IV-TR and DSM-5 diagnostic criteria identified the same proportion of participants (54.2%) as having some type of eating disorder pathology. However, participants were more likely to be classified into a full-threshold eating disorder pathology group (anorexia nervosa, bulimia nervosa, and binge eating disorder) when using the DSM-5 criteria (57.0%) versus DSM-IV-TR criteria (50.9%). Additionally, little to no information was lost using DSM-5 criteria in validating anxiety and depression severity scores among eating disorder pathology groups. Although DSM-5 criteria reduced the percent classified with eating disorders not otherwise specified (EDNOS), a majority still received this categorisation. Continued differentiation of attitudinal and behavioural features of EDNOS is needed to further refine the diagnostic criteria for eating disorders.
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