title: The impact of revised DSM-5 criteria on the relative distribution and inter-rater reliability of eating disorder diagnoses in a residential treatment setting.
abstract: This study evaluated the relative distribution and inter-rater reliability of revised DSM-5 criteria for eating disorders in a residential treatment program. Consecutive adolescent and young adult females (N=150) admitted to a residential eating disorder treatment facility were assigned both DSM-IV and DSM-5 diagnoses by a clinician (n=14) via routine clinical interview and a research assessor (n=4) via structured interview. We compared the frequency of diagnostic assignments under each taxonomy and by type of assessor. We evaluated concordance between clinician and researcher assignment through inter-rater reliability kappa and percent agreement. Significantly fewer patients received either clinician or researcher diagnoses of a residual eating disorder under DSM-5 (clinician-12.0%; researcher-31.3%) versus DSM-IV (clinician-28.7%; researcher-59.3%), with the majority of reassigned DSM-IV residual cases reclassified as DSM-5 anorexia nervosa. Researcher and clinician diagnoses showed moderate inter-rater reliability under DSM-IV (κ=.48) and DSM-5 (κ=.57), though agreement for specific DSM-5 other specified feeding or eating disorder (OSFED) presentations was poor (κ=.05). DSM-5 revisions were associated with significantly less frequent residual eating disorder diagnoses, but not with reduced inter-rater reliability. Findings support specific dimensions of clinical utility for revised DSM-5 criteria for eating disorders.
authors.affiliation: Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston , MA, USA. Electronic address: jjthomas@mgh.harvard.edu.
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Thomas
authors.affiliation: Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston , MA, USA.
authors.forename: Kamryn T
authors.initials: KT
authors.lastname: Eddy
authors.affiliation: Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA, USA.
authors.forename: Helen B
authors.initials: HB
authors.lastname: Murray
authors.affiliation: Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA, USA.
authors.forename: Marilou D P
authors.initials: MD
authors.lastname: Tromp
authors.affiliation: Institute of Psychology, University of Osnabrück, Neuer Graben, 49074 Osnabrück, Germany.
authors.forename: Andrea S
authors.initials: AS
authors.lastname: Hartmann
authors.affiliation: Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston , MA, USA.
authors.forename: Melissa T
authors.initials: MT
authors.lastname: Stone
authors.affiliation: Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston , MA, USA; Klarman Eating Disorders Center, McLean Hospital, 115 Mill Street, Belmont, MA, USA.
authors.forename: Philip G
authors.initials: PG
authors.lastname: Levendusky
authors.affiliation: Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston , MA, USA; Department of Global Health & Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, USA.
authors.forename: Anne E
authors.initials: AE
authors.lastname: Becker
mesh_terms: D000293:Adolescent; D000328:Adult; D000856:Anorexia Nervosa / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D039721:Diagnostic and Statistical Manual of Mental Disorders; D001068:Feeding and Eating Disorders / Q000175:diagnosis* / Q000523:psychology* / Q000628:therapy; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D015588:Observer Variation; D015203:Reproducibility of Results; D012114:Residential Treatment / Q000379:methods / Q000592:standards*; D016896:Treatment Outcome; D055815:Young Adult
keywords: DSM-5; Diagnostic reliability; Eating disorder; Eating disorder not otherwise specified (EDNOS); Other specified feeding or eating disorder (OSFED)