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Comparative Study
. 2008 Feb;165(2):245-50.
doi: 10.1176/appi.ajp.2007.07060951. Epub 2008 Jan 15.

Diagnostic crossover in anorexia nervosa and bulimia nervosa: implications for DSM-V

Kamryn T Eddy  1 , David J Dorer, Debra L Franko, Kavita Tahilani, Heather Thompson-Brenner, David B Herzog
Affiliations
Comparative Study

Diagnostic crossover in anorexia nervosa and bulimia nervosa: implications for DSM-V

Kamryn T Eddy et al. Am J Psychiatry. 2008 Feb.

Abstract

Objective: The Diagnostic and Statistical Manual of Mental Disorders (DSM) is designed primarily as a clinical tool. Yet high rates of diagnostic "crossover" among the anorexia nervosa subtypes and bulimia nervosa may reflect problems with the validity of the current diagnostic schema, thereby limiting its clinical utility. This study was designed to examine diagnostic crossover longitudinally in anorexia nervosa and bulimia nervosa to inform the validity of the DSM-IV-TR eating disorders classification system.

Method: A total of 216 women with a diagnosis of anorexia nervosa or bulimia nervosa were followed for 7 years; weekly eating disorder symptom data collected using the Eating Disorder Longitudinal Interval Follow-Up Examination allowed for diagnoses to be made throughout the follow-up period.

Results: Over 7 years, the majority of women with anorexia nervosa experienced diagnostic crossover: more than half crossed between the restricting and binge eating/purging anorexia nervosa subtypes over time; one-third crossed over to bulimia nervosa but were likely to relapse into anorexia nervosa. Women with bulimia nervosa were unlikely to cross over to anorexia nervosa.

Conclusions: These findings support the longitudinal distinction of anorexia nervosa and bulimia nervosa but do not support the anorexia nervosa subtyping schema.

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Figures

FIGURE 1
FIGURE 1
Longitudinal Course and Crossover for Participants With an Intake Diagnosis of Anorexia Nervosa, Restricting Type (N=40)a a Each row in the figure represents one participant.
FIGURE 2
FIGURE 2
Longitudinal Course and Crossover for Participants With an Intake Diagnosis of Anorexia Nervosa, Binge Eating/Purging Type (N=48)a a Each row in the figure represents one participant.
FIGURE 3
FIGURE 3
Longitudinal Course and Crossover for Participants With an Intake Diagnosis of Bulimia Nervosa (N=128)a a Each row in the figure represents one participant.
See this image and copyright information in PMC

Comment in

  • The value of anorexia nervosa subtypes.
    Favaro A, Santonastaso P. Favaro A, et al. Am J Psychiatry. 2008 Jun;165(6):772-3; author reply 773. doi: 10.1176/appi.ajp.2008.08020172. Am J Psychiatry. 2008. PMID: 18519536 No abstract available.

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