Diagnostic classification of eating disorders in children and adolescents: how does DSM-IV-TR compare to empirically-derived categories?
OBJECTIVE
The purpose of this study was to empirically derive eating disorder phenotypes in a clinical sample of children and adolescents using latent profile analysis (LPA), and to compare these latent profile (LP) groups to the DSM-IV-TR eating disorder categories.


METHODS
Eating disorder symptom data collected from 401 youth (aged 7 through 19 years; mean 15.14 +/- 2.35 years) seeking eating disorder treatment were included in LPA; general linear models were used to compare LP groups to DSM-IV-TR eating disorder categories on pretreatment and outcome indices.


RESULTS
Three LP groups were identified: LP1 (n = 144), characterized by binge eating and purging ("Binge/purge"); LP2 (n = 126), characterized by excessive exercise and extreme eating disorder cognitions ("Exercise-extreme cognitions"); and LP3 (n = 131), characterized by minimal eating disorder behaviors and cognitions ("Minimal behaviors/cognitions"). Identified LPs imperfectly resembled DSM-IV-TR eating disorders. LP1 resembled bulimia nervosa; LP2 and LP3 broadly resembled anorexia nervosa with a relaxed weight criterion, differentiated by excessive exercise and severity of eating disorder cognitions. The LP groups were more differentiated than the DSM-IV-TR categories across pretreatment eating disorder and general psychopathology indices, as well as weight change at follow-up. Neither LP nor DSM-IV-TR categories predicted change in binge/purge behaviors. Validation analyses suggest these empirically derived groups improve upon the current DSM-IV-TR categories.


CONCLUSIONS
In children and adolescents, revisions for DSM-V should consider recognition of patients with minimal cognitive eating disorder symptoms.
Eddy
Kamryn T
KT
Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA. keddy@partners.org
Le Grange
Daniel
D
Crosby
Ross D
RD
Hoste
Renee Rienecke
RR
Doyle
Angela Celio
AC
Smyth
Angela
A
Herzog
David B
DB
D000293:Adolescent; D000856:Anorexia Nervosa / Q000145:classification / Q000175:diagnosis / Q000523:psychology; D001294:Attitude to Health; D056912:Binge-Eating Disorder / Q000145:classification / Q000175:diagnosis / Q000523:psychology; D001828:Body Image; D052018:Bulimia Nervosa / Q000145:classification / Q000175:diagnosis / Q000523:psychology; D002641:Chicago; D002648:Child; D003863:Depression / Q000145:classification / Q000175:diagnosis / Q000523:psychology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D015444:Exercise / Q000523:psychology; D001068:Feeding and Eating Disorders / Q000145:classification* / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D010044:Outpatient Clinics, Hospital; D010555:Personality Inventory; D010641:Phenotype; D012649:Self Concept
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