title: Evaluation of the DSM-5 severity indicator for binge eating disorder in a clinical sample.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Psychiatry, Yale School of Medicine, United States; Department of Psychology, Yale University, United States. Electronic address: carlos.grilo@yale.edu.
authors.forename: Carlos M
authors.initials: CM
authors.lastname: Grilo
authors.affiliation: Department of Psychiatry, Yale School of Medicine, United States.
authors.forename: Valentina
authors.initials: V
authors.lastname: Ivezaj
authors.affiliation: Department of Psychiatry, Yale School of Medicine, United States; Yale School of Public Health, United States.
authors.forename: Marney A
authors.initials: MA
authors.lastname: White
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D056912:Binge-Eating Disorder / Q000175:diagnosis*; D001828:Body Image; D001835:Body Weight; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D055815:Young Adult
keywords: Binge eating; Body image; Diagnosis; Obesity; Severity