Diagnostic Classification of Eating Disorders in Children and Adolescents: How Does DSM-IV-TR Compare to Empirically-Derived Categories?

Abstract

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. 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. 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. In children and adolescents, revisions for DSM-V should consider recognition of patients with minimal cognitive eating disorder symptoms.