Evaluation of the DSM-5 Eating Disorder Severity Indices of Bulimic Syndromes

Abstract

A major change to the DSM-5 was the integration of a new severity rating system, ranging from mild to extreme, with key parameters for each eating disorder. However, few studies have examined the clinical utility of these new severity indices. The aim of this project was to identify variables that predict psychosocial impairment in a community sample of individuals with eating disorders in order to inform future diagnostic definitions of severity. Participants were individuals with eating disorders (N=189; 19.9% men) recruited from two Midwestern communities. Participants completed the Eating Pathology Symptoms Inventory (EPSI), Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) adjusted for DSM-5 criteria, NEO Five-Factor Inventory-3 (NEO-FFI-3), and the World Health Organization Disability Assessment Schedule 2.0 (WHO-DAS 2.0). The Bayesian Information Criterion (BIC) was used to compare the fit of path models to the data. Individual model fit was assessed using overall model chi-square, comparative fit index (CFI), Tucker-Lewis Fit Index (TFI), and root-mean-square-error of approximation (RMSEA). Results provided some support for current DSM-5 severity indicators for BN and BED. Findings indicated limited support for DSM-5’s current severity indices. Two alternative methods for determining eating disorder severity, using binge eating and restricting frequency as predictors of psychosocial dysfunction, were identified. However, results also suggested that future evaluation of severity indices might benefit from integrating mood, anxiety, and eating disorder symptom based models of severity.