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Testing the DSM-5 severity indicator for bulimia nervosa in a treatment-seeking sample

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Abstract

Purpose

This study tested the new DSM-5 severity criterion for bulimia nervosa (BN) based on the frequency of inappropriate weight compensatory behaviors in a treatment-seeking sample.

Methods

Participants were 345 adults with DSM-5 BN presenting for treatment. They were sub-grouped based on DSM-5 severity levels and compared on a range of variables of clinical interest and demographics.

Results

Based on DSM-5 severity definitions, 27.2 % of the sample was categorized with mild, 26.1 % with moderate, 24.9 % with severe, and 21.8 % with extreme severity of BN. Analyses revealed that the four (mild, moderate, severe, and extreme) severity groups of BN significantly differed from each other in eating disordered and body-related attitudes and behaviors, factors involved in the maintenance process of the disorder, comorbid psychiatric disorders, psychological distress, and psychosocial impairment (medium-to-large effect sizes). No significant between-group differences were observed in demographics, body mass index, or at the age when BN first occurred, lending some credence to recent suggestions that age-at-onset of BN may be more a disorder- than a severity-dependent variable.

Conclusions

Collectively, our findings provide support for the severity indicator for BN introduced in the DSM-5 as a means of addressing heterogeneity and variability in the severity of the disorder.

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Notes

  1. Since preliminary analysis did not detect any significant differences among the five Italian sites (where data were originally collected) [18, 19] in the portion of patients classified with mild, moderate, severe, and extreme severity of BN, the entire sample of 345 DSM-5 BN patients was sub-grouped into the four DSM-severity groups. Also, preliminary analysis did not detect any significant differences among the Italian specialized care centres for EDs (sites) in any variables considered (in and) for the purposes of this study including demographics of patients classified with mild, moderate, severe, and extreme severity of BN; thus, the results that follow are not stratified by site.

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Authors and Affiliations

  1. Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900, Monza, Italy

    Antonios Dakanalis, Massimo Clerici & Giuseppe Carrà

  2. Department of Brain and Behavioral Sciences, University of Pavia, P.za Botta 11, 27100, Pavia, Italy

    Antonios Dakanalis

  3. Department of Psychology, Catholic University, Largo Gemelli 1, 20123, Milan, Italy

    Giuseppe Riva

  4. Applied Technology for Neuro-Psychology Laboratory, Istituto Auxologico Italiano, IRCCS, Via Ariosto 13, 20145, Milan, Italy

    Giuseppe Riva

  5. Division of Psychiatry, Faculty of Brain Sciences, University College of London, Gower Street, London, WC1E 6BT, UK

    Giuseppe Carrà

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  1. Antonios Dakanalis
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  2. Massimo Clerici
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  3. Giuseppe Riva
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  4. Giuseppe Carrà
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Correspondence to Antonios Dakanalis.

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Conflict of interest

This research received no specific grant from any funding agency, commercial or not for-profit sectors and the authors declare that they have no conflicts of interest.

Ethical approval

The study was performed in compliance with the Helsinki Declaration of 1975, as revised in 2008, and the study protocol was approved by the ethics review board of each local institution (recruitment/participating site) and of the co-ordinating body of the project (University of Pavia).

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All participants provided written informed consent.

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Dakanalis, A., Clerici, M., Riva, G. et al. Testing the DSM-5 severity indicator for bulimia nervosa in a treatment-seeking sample. Eat Weight Disord 22, 161–167 (2017). https://doi.org/10.1007/s40519-016-0324-2

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