title: The validity and utility of subtyping bulimia nervosa.
abstract: OBJECTIVE
  To review the evidence for the validity and utility of subtyping bulimia nervosa (BN) into a purging (BN-P) and a nonpurging subtype (BN-NP), and of distinguishing BN-NP from binge eating disorder (BED), by comparing course, complications, and treatment.
  
  
  METHODS
  A literature search of psychiatry databases for studies published in peer-reviewed journals that used the DSM-definitions of BN and BED, and included both individuals with BN-NP and individuals with BN-P and/or BED.
  
  
  RESULTS
  Twenty-three studies compared individuals with BN-NP (N = 671) to individuals with BN-P (N = 1795) and/or individuals with BED (N = 1921), two of which reported on course, 12 on comorbidity and none on treatment response-the indicators for validity and clinical utility. The differences found were mainly quantitative rather than qualitative, suggesting a gradual difference in severity from BN-P (most severe) through BN-NP to BED (least severe).
  
  
  CONCLUSIONS
  None of the comparisons provided convincing evidence for the validity or utility of the BN-NP diagnosis. Three options for the position of BN-NP in DSM-V were suggested: (1) maintaining the BN-NP subtype, (2) dropping nonpurging compensatory behavior as a criterion for BN, so that individuals currently designated as having BN-NP would be designated as having BED, and (3) including BN-NP in a broad BN category.
authors.affiliation: Department of Research, Parnassia Bavo Psychiatric Institute, The Hague, The Netherlands.
authors.forename: Daphne
authors.initials: D
authors.lastname: van Hoeken
authors.forename: Wim
authors.initials: W
authors.lastname: Veling
authors.forename: Sjoukje
authors.initials: S
authors.lastname: Sinke
authors.forename: James E
authors.initials: JE
authors.lastname: Mitchell
authors.forename: Hans W
authors.initials: HW
authors.lastname: Hoek
mesh_terms: D002032:Bulimia / Q000145:classification / Q000175:diagnosis; D052018:Bulimia Nervosa / Q000145:classification* / Q000175:diagnosis; D039721:Diagnostic and Statistical Manual of Mental Disorders; D006801:Humans; D014839:Vomiting / Q000523:psychology