Problems Applying the DSM-IV Eating Disorders Diagnostic Criteria in a General Psychiatric Outpatient Practice
J Clin Psychiatry 2008;69(3):381-384
© Copyright 2015 Physicians Postgraduate Press, Inc.
Purchase This PDF for $40.00
If you are not a paid subscriber, you may purchase the PDF.
(You'll need the free Adobe Acrobat Reader.)
Receive immediate full-text access to JCP. You can subscribe to JCP online-only ($86) or print + online ($156 individual).
With your subscription, receive a free PDF collection of the NCDEU Festschrift articles. Hurry! This offer ends December 31, 2011.
If you are a paid subscriber to JCP and do not yet have a username and password, activate your subscription now.
As a paid subscriber who has activated your subscription, you have access to the HTML and PDF versions of this item.
Click here to login.
Did you forget your password?
Still can't log in? Contact the Circulation Department at 1-800-489-1001 x4 or send email
Objective: A substantial number of patients treated in
specialized eating disorder programs fail to meet criteria for anorexia nervosa
or bulimia nervosa, the 2 eating disorders with specified criteria in DSM-IV,
and are diagnosed with eating disorder not otherwise specified (NOS). In a
general psychiatric setting, where the severity of eating pathology is likely
to be milder than in specialty programs, we predicted that most patients with
disordered eating would fail to meet the full criteria for one of the DSM-IV
eating disorders and instead would be diagnosed with eating disorder NOS.
Method: Two thousand five hundred psychiatric outpatients were
interviewed with the Structured Clinical Interview for DSM-IV (SCID) upon
presentation for treatment. The findings presented in this report were derived
from patients interviewed from December 1995 to August 2006.
Results: Thirteen percent (N = 330) of the patients were
diagnosed with a lifetime history of an eating disorder, 307 of whom received 1
diagnosis and 23 of whom were diagnosed with 2 disorders. Almost half (N = 164)
of the disorders were present at the time of presentation, approximately one
sixth (N = 60) were considered to be in partial remission, and slightly more
than one third (N = 129) were past diagnoses. When binge-eating disorder was
combined with the other forms of eating disorder NOS, as it is in DSM-IV, 90.2%
(148/164) of the patients with a current eating disorder were diagnosed with
eating disorder NOS.
Conclusions: The preponderance of eating-disordered patients
in a general psychiatric setting were diagnosed with eating disorder NOS. This
finding suggests that there is a problem with the clinical applicability of the
diagnostic criteria in the DSM-IV eating disorder category.