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Evaluation of the DSM-5 severity indicator for binge eating disorder in a community sample

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Highlights

  • Binge eating disorder (BED) included as a formal diagnosis in DSM-5.

  • Examined DSM-5 severity specifier based on frequency of binge eating episodes.

  • Findings provide new, but limited, support for DSM-5 severity specifier for BED.

  • Shape/weight overvaluation supported as an alternative severity specifier for BED.

  • Further research is needed with treatment-seeking clinical samples with BED.

Abstract

Research has examined various aspects of the diagnostic criteria for binge-eating disorder (BED) but has yet to evaluate the DSM-5 severity criterion. This study examined the DSM-5 severity criterion for BED based on binge-eating frequency and tested an alternative severity specifier based on overvaluation of shape/weight. 338 community volunteers categorized with DSM-5 BED completed a battery of self-report instruments. Participants were categorized first using DSM-5 severity levels and second by shape/weight overvaluation and were compared on clinical variables. 264 (78.1%) participants were categorized as mild, 67 (19.8%) as moderate, 6 (1.8%) as severe, and 1 (0.3%) as extreme. Analyses comparing mild and moderate severity groups revealed no significant differences in demographic variables or BMI; the moderate severity group had greater eating-disorder psychopathology (small effect-sizes) but not depression than the mild group. Participants with overvaluation (N = 196; 60.1%) versus without (N = 130; 39.9%) did not differ significantly in age, sex, BMI, or binge-eating frequency. The overvaluation group had significantly greater eating-disorder psychopathology and depression than the non-overvaluation group. The greater eating-disorder and depression levels (medium-to-large effect-sizes) persisted after adjusting for ethnicity/race and binge-eating severity/frequency, without attenuation of effect-sizes. Findings from this non-clinical community sample provide support for overvaluation of shape/weight as a specifier for BED as it provides stronger information about severity than the DSM-5 rating based on binge-eating. Future research should include treatment-seeking patients with BED to test the utility of DSM-5 severity specifiers and include broader clinical validators.

Section snippets

Participants

Participants were 338 community volunteers drawn from a larger series of 3283 respondents to online advertisements seeking volunteers aged 18 years or older for a research study about eating and dieting. Participants were selected from the larger sample per criteria used to define our study group of persons with BED. Advertisements with a link to a web survey were placed on Craigslist internet classified ads in various US cities in order to enhance geographic generalizability. The participant

Binge eating disorder: DSM-5 severity groups

In the overall participant group of N = 338 with BED, the following DSM-5-defined severity groups (based on frequency of binge eating episodes) were observed: 264 (78.1%) categorized as mild (defined as 1–3 episodes/week), 67 (19.8%) as moderate (4–7 episodes/week), 6 (1.8%) as severe (8–13 episodes/week), and 1 (.3%) as extreme (14 or more episodes/week). Thus, analyses compared mild versus moderate severity groups; the low frequency of severe and extreme severity groups precluded their

Discussion

This study yielded two primary findings. First, the findings provide new, albeit limited, support for the DSM-5 severity criterion for BED. In this non-clinical study group of community volunteers, nearly no participants were categorized with either severe or extreme severity of BED based on their self-reported binge-eating frequency. Participants with BED categorized with moderate severity had significantly greater eating-disorder psychopathology but not depression than participants

Disclosure and conflict of interest

This research was supported, in part, by National Institutes of Health grants K24 DK070052 (Dr. Grilo). The authors declared that there is no conflict of interest.

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