title: Do DSM-5 eating disorder criteria overpathologize normative eating patterns among individuals with obesity?
abstract: BACKGROUND
  DSM-5 revisions have been criticized in the popular press for overpathologizing normative eating patterns-particularly among individuals with obesity. To evaluate the evidence for this and other DSM-5 critiques, we compared the point prevalence and interrater reliability of DSM-IV versus DSM-5 eating disorders (EDs) among adults seeking weight-loss treatment.
  
  
  METHODS
  Clinicians (n = 2) assigned DSM-IV and DSM-5 ED diagnoses to 100 participants via routine clinical interview. Research assessors (n = 3) independently conferred ED diagnoses via Structured Clinical Interview for DSM-IV and a DSM-5 checklist.
  
  
  RESULTS
  Research assessors diagnosed a similar proportion of participants with EDs under DSM-IV (29%) versus DSM-5 (32%). DSM-5 research diagnoses included binge eating disorder (9%), bulimia nervosa (2%), subthreshold binge eating disorder (5%), subthreshold bulimia nervosa (2%), purging disorder (1%), night eating syndrome (6%), and other (7%). Interrater reliability between clinicians and research assessors was "substantial" for both DSM-IV (κ = 0.64, 84% agreement) and DSM-5 (κ = 0.63, 83% agreement).
  
  
  CONCLUSIONS
  DSM-5 ED criteria can be reliably applied in an obesity treatment setting and appear to yield an overall ED point prevalence comparable to DSM-IV.
authors: Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA 02114, USA ; Department of Psychiatry, Harvard Medical School, Boston, MA 02114, USA.
authors: Jennifer J
authors: 0000-0003-2601-581X
authors: JJ
authors: Thomas
authors: Department of Psychiatry, Harvard Medical School, Boston, MA 02114, USA.
authors: Katherine A
authors: 0000-0002-5076-3642
authors: KA
authors: Koh
authors: Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA 02114, USA ; Department of Psychiatry, Harvard Medical School, Boston, MA 02114, USA.
authors: Kamryn T
authors: KT
authors: Eddy
authors: Institute for Psychology, University of Osnabrück, 49074 Osnabrück, Germany.
authors: Andrea S
authors: 0000-0002-6251-3763
authors: AS
authors: Hartmann
authors: Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA 02114, USA.
authors: Helen B
authors: HB
authors: Murray
authors: Department of Psychiatry, Harvard Medical School, Boston, MA 02114, USA ; Massachusetts General Hospital Weight Center, Boston, MA 02114, USA.
authors: Mark J
authors: MJ
authors: Gorman
authors: Department of Psychiatry, Harvard Medical School, Boston, MA 02114, USA ; Massachusetts General Hospital Weight Center, Boston, MA 02114, USA.
authors: Stephanie
authors: 0000-0001-9848-0097
authors: S
authors: Sogg
authors: Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA 02114, USA ; Department of Psychiatry, Harvard Medical School, Boston, MA 02114, USA ; Department of Global Health & Social Medicine, Harvard Medical School, Boston, MA 02115, USA.
authors: Anne E
authors: 0000-0001-9129-6510
authors: AE
authors: Becker
mesh_terms: D000328:Adult; D056912:Binge-Eating Disorder / Q000150:complications / Q000175:diagnosis; D002032:Bulimia / Q000150:complications / Q000175:diagnosis; D052018:Bulimia Nervosa / Q000150:complications / Q000175:diagnosis; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005247:Feeding Behavior; D001068:Feeding and Eating Disorders / Q000150:complications / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D015588:Observer Variation; D012016:Reference Values; D015203:Reproducibility of Results