ارزیابی شاخص حدت DSM-5 برای اختلال پرخوری افراطی در یک جامعه نمونه‌ای

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.

Binge-eating disorder (BED), a new formal diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5; APA, 2013), is defined by recurrent binge eating (i.e., eating unusually large quantities of food accompanied by subjective feelings of loss of control) occurring an average of once-weekly during the past three months, the presence of at least three of five behavioral indicators signaling a loss of control over eating, marked distress about the binge eating, and the absence of extreme weight compensatory behaviors (e.g., purging) that characterize bulimia nervosa (BN). Following the inclusion of BED in Appendix B of the DSM-IV ( APA, 1994) as a research criteria set requiring further study, research produced empirical support for the clinical utility and validity of this diagnostic construct ( Wilfley et al., 2007 and Wonderlich et al., 2009) including its distinctiveness from obesity and other eating disorders ( Grilo et al., 2009 and Grilo et al., 2010). Leading up to DSM-5, there were questions about whether revisions or additions to its criteria would improve the construct ( Masheb and Grilo, 2000 and Wilfley et al., 2007). Research examined aspects of the DSM-IV research criteria for BED including, for example, the frequency and duration stipulation requirements for binge-eating. Research indicated that a once-weekly frequency of binge-eating signaled a clinically relevant problem ( Wilson & Sysko, 2009) and DSM-5 adopted a once-weekly frequency of binge-eating as the new criterion for both BED and BN with a similar duration requirement of three months. Research examining the “unusually large amount” requirement for determining binge-eating received limited support (Mond, Hay, Rodgers, & Owen, 2010) and was not changed in the DSM-5. Other components of the BED diagnosis received very little empirical attention although they were supported: one study documented the diagnostic efficiency of the behavioral indicators of impaired control used to determine the loss of control aspect of binge-eating ( White & Grilo, 2011), one study showed the diagnostic utility of the “marked distress” criterion requirement ( Grilo & White, 2011), and one study reported improved test-retest reliability for proposed DSM-5 vs DSM-IV research criteria for BED ( Sysko et al., 2012). The DSM-5, in addition to changing the binge-eating frequency and duration requirements for BED (i.e., from a weekly average of two days with binge-eating episodes during the past six months to an average of once weekly binge-eating episodes during the past three months), made one more change which involved a new “severity specifier” based on the frequency of binge eating. The DSM-5 proposed four severity groups based on the frequency of binge eating episodes: mild (1–3 episodes/week), moderate (4–7 episodes/week), severe (8–13 episodes/week), and extreme (14 or more episodes/week). Although the literature supported the new minimum criterion of once-weekly frequency of binge eating for the diagnosis of BED ( Wilson & Sysko, 2009), we are unaware of empirical research supporting the proposed severity specifier for BED. Although other eating disorder diagnoses include a cognitive criterion pertaining to body image (e.g., in the case of BN, the presence of “undue influence of body weight or shape on self-evaluation) a body-image criterion was not included as part of the BED diagnosis in either DSM-IV (see Masheb & Grilo, 2000) or DSM-5. Despite consistent empirical findings that the cognitive body-image construct – referred to as “overvaluation of shape/weight” ( Grilo, 2013) – should serve as a diagnostic severity specifier for BED ( Goldschmidt et al., 2010, Grilo et al., 2009, Grilo et al., 2008, Grilo et al., 2010, Grilo et al., 2013, Grilo et al., 2012 and Hrabosky et al., 2007), the DSM-5 did not include a body-image component for BED. Thus, research has examined various aspects of the validity of the diagnostic criteria for BED but has yet to evaluate the utility of the DSM-5 severity criterion. This study examined the DSM-5 severity criterion for BED based on the frequency of binge eating and tested an alternative severity specifier based on overvaluation of shape/weight.