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Int J Eat Disord. 2017 Aug;50(8):906-916. doi: 10.1002/eat.22728. Epub 2017 May 10.

Mild, moderate, meaningful? Examining the psychological and functioning correlates of DSM-5 eating disorder severity specifiers.

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Department of Psychiatry, Columbia University Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York, New York.
Department of Medical Ethics & Health Policy, Perelman School of Medicine, University of Pennsylvania, Blockley Hall, Philadelphia, Pennsylvania.
Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA.
Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, Massachusetts.
Department of Psychiatry, Yale University School of Medicine, 301 Cedar Street, New Haven, Connecticut.
Department of Psychology, Yale University, Box 208205, New Haven, Connecticut.
Klarman Center, McLean Hospital and Harvard Medical School, Belmont, Massachusetts.
Eating and Weight Disorders Program, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1230, New York, New York.



This study evaluated the DSM-5 severity specifiers for treatment-seeking groups of participants with anorexia nervosa (AN), the purging form of bulimia nervosa (BN), and binge-eating disorder (BED).


Hundred and sixty-two participants with AN, 93 participants with BN, and 343 participants with BED were diagnosed using semi-structured interviews, sub-categorized using DSM-5 severity specifiers and compared on demographic and cross-sectional clinical measures.


In AN, the number of previous hospitalizations and the duration of illness increased with severity, but there was no difference across severity groups on measures of eating pathology, depression, or measures of self-reported physical or emotional functioning. In BN, the level of eating concerns increased across the severity groups, but the groups did not differ on measures of depression, self-esteem, and most eating pathology variables. In BN, support was also found for an alternative severity classification scheme based upon number of methods of purging. In BED, levels of several measures of eating pathology and self-reported physical and emotional functioning increased across the severity groups. For BED, however, support was also found for an alternative severity classification scheme based upon overvaluation of shape and weight. Preliminary evidence was also found for a transdiagnostic severity index based upon overvaluation of shape and weight.


Overall, these data show limited support for the DSM-5 severity specifiers for BN and modest support for the DSM-5 severity specifiers for AN and BED.


DSM-5; anorexia nervosa; binge-eating disorder; bulimia nervosa; diagnosis; severity

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