Overvaluation of shape and weight in binge eating disorder, bulimia nervosa, and sub-threshold bulimia nervosa

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Abstract

Increasing empirical evidence supports the validity of binge eating disorder (BED), a research diagnosis in the appendix of DSM-IV, and its inclusion as a distinct and formal diagnosis in the DSM-V. A pressing question regarding the specific criteria for BED diagnosis is whether, like bulimia nervosa (BN), it should be characterized by overvaluation of shape and weight. This study compared features of eating disorders in 436 treatment-seeking women comprising four groups: 195 BED participants who overvalue their shape/weight, 129 BED participants with subclinical levels of overvaluation, 61 BN participants, and 51 participants with sub-threshold BN. The BED clinical overvaluation group had significantly higher levels of specific eating disorder psychopathology than the three other groups which did not differ significantly from each other. Findings suggest that overvaluation of shape and weight should not be considered as a required criterion for BED because this would exclude a substantial proportion of BED patients with clinically significant problems. Rather, overvaluation of shape and weight warrants consideration either as a diagnostic specifier or as a dimensional severity rating as it provides important information about severity within BED.

Section snippets

Participants

Participants were 436 women evaluated for treatment studies at the department of psychiatry at Yale University and the Neuropsychiatric Research Institute at the University of North Dakota (NRI/UND). These advertisements specifically targeted patients with BED (Yale University) or BN (NRI/UND). Study inclusion criteria required meeting DSM-IV full research criteria for BED, full criteria for BN, or sub-threshold criteria for BN. Sub-threshold BN was defined as either full BN criteria except

Results

Of the 324 participants with BED, 60% (n = 195) had clinical overvaluation and 40% (n = 129) with subclinical overvaluation. As expected, per the DSM-IV criteria determined using the SCID-I/P, the BED, BN, and sub-threshold BN groups differed significantly in the proportion of participants meeting overvaluation thresholds on the EDE (χ2 (2, N = 436)) = 37.56, (p < .001). Clinical overvaluation was nearly universal in the BN patients: 95% (58 of 61) participants with BN and 86% (44 of 51)

Discussion

This study examined the significance of overvaluation of shape/weight for the diagnosis of BED by comparing BED patients who overvalue their shape/weight, BED patients with subclinical levels of overvaluation, BN patients, and sub-threshold BN patients. Whereas clinical overvaluation is nearly universal in patients with BN and even among those with sub-threshold BN, only 60% of BED patients met research convention criteria for clinical overvaluation. When overvaluation of shape/weight was

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    Supported by the National Institutes of Health (DK056735, DK49587, DK071646, DK070052, MHDK058820, and MH65919).

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