EDDA: an eating disorder diagnostic algorithm according to ICD-11

Abstract

This paper was developed as a part of discussions related to the World Health Organization’s (WHO’s) revision of the ICD-10, although the ideas presented here do not represent official proposals. The changes in the classification of feeding and eating disorders (EDs) in the upcoming ICD-11 necessitate the development of new diagnostic/ screening instruments as old instruments will become less relevant because they will not be consistent with the most up-to-date diagnostic systems unless they are revised. This paper describes the process of development of one such computerized tool for assessment and diagnosis of EDs according to ICD-11. At present, the Composite International Diagnostic Interview (CIDI), the Eating Disorder Examination (EDE) and its self-report questionnaire version the EDE-Q are used most commonly to generate ED diagnoses or rate ED psychopathology, respectively [1, 2]. The CIDI, developed by the WHO, can generate diagnoses for both the ICD-10 and the DSM-IV [1] but requires training for proper use. The EDE/EDE-Q [2], in contrast, provide extensive information on multiple eating problems and is often considered the method of choice for assessment of EDs but does not generate ICD-10 diagnoses. Numerous other screening and diagnostic tools, including the Eating Attitudes Test [3], Body Attitudes Questionnaire [4], Questionnaire for Eating Disorder Diagnoses [5], Eating Disorder Diagnostic Scale [6], SCOFF questionnaire [7], Minnesota Eating Behavior Survey [8], look into specific aspects of ED without necessarily generating ICD diagnosis. Rather, use of these multiple instruments results in wide variations in the reported prevalence of ED and makes studies difficult to compare. Thus the need for a research and diagnostic tool that reflects the current classification of EDs becomes paramount. Further, in lowand middle income countries, EDs are likely to be dealt with in primary health-care settings, possibly by nurses or other health care workers without training in mental health. Even in high-income countries, sufferers of ED are likely to wait for a considerable time before being seen by an ED specialist [9]. Individuals suffering from EDs and their parents or other carers often want a simple method that can help them decide whether there is a need to seek help. Thus, in order to recognise EDs and their development at an early stage, we aim to provide a computerized questionnaire that can also be used as a semi-structured interview for the understanding of eating problems. Additionally, this software has its utility as a tool to create ICD11 ED classifications and codes proposed in a companion paper (Thiels, this issue).