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Behav Res Ther. 2015 Aug;71:110-4. doi: 10.1016/j.brat.2015.05.003. Epub 2015 Jun 12.

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

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Department of Psychiatry, Yale School of Medicine, United States; Department of Psychology, Yale University, United States. Electronic address:
Department of Psychiatry, Yale School of Medicine, United States.
Department of Psychiatry, Yale School of Medicine, United States; Yale School of Public Health, United States.



This study tested the new DSM-5 severity criterion for binge eating disorder (BED) based on frequency of binge-eating in a clinical sample. This study also tested overvaluation of shape/weight as an alternative severity specifier.


Participants were 834 treatment-seeking adults diagnosed with DSM-5 BED using semi-structured diagnostic and eating-disorder interviews. Participants sub-grouped based on DSM-5 severity levels and on overvaluation of shape/weight were compared on demographic and clinical variables.


Based on DSM-5 severity definitions, 331 (39.7%) participants were categorized as mild, 395 (47.5%) as moderate, 83 (10.0%) as severe, and 25 (3.0%) as extreme. Analyses comparing three (mild, moderate, and severe/extreme) severity groups revealed no significant differences in demographic variables or body mass index (BMI). Analyses revealed significantly higher eating-disorder psychopathology in the severe/extreme than moderate and mild groups and higher depression in moderate and severe/extreme groups than the mild group; effect sizes were small. Participants characterized with overvaluation (N = 449; 54%) versus without overvaluation (N = 384; 46%) did not differ significantly in age, sex, BMI, or binge-eating frequency, but had significantly greater eating-disorder psychopathology and depression. The robustly greater eating-disorder psychopathology and depression levels (medium-to-large effect sizes) in the overvaluation group was observed without attenuation of effect sizes after adjusting for ethnicity/race and binge-eating severity/frequency.


Our findings provide support for overvaluation of shape/weight as a severity specifier for BED as it provides stronger information about the severity of homogeneous groupings of patients than the DSM-5 rating based on binge-eating.


Binge eating; Body image; Diagnosis; Obesity; Severity

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