The validity and utility of subtyping bulimia nervosa

Daphne van Hoeken, Wim Veling, Sjoukje Sinke, James E. Mitchell, Hans W. Hoek*

*Corresponding author for this work

    Research output: Contribution to journalReview articlepeer-review

    34 Citations (Scopus)

    Abstract

    Objective: To review the evidence for the validity and utility of subtyping bulimia nervosa (BN) into a purging (BN-P) and a nonpurging subtype (BN-NP), and of distinguishing BN-NP from binge eating disorder (BED), by comparing course, complications, and treatment.

    Method: A literature search of psychiatry databases for studies published in peer-reviewed journals that used the DSM-definitions of BIN and BED, and included both individuals with BN-NP and individuals with BN-P and/or BED.

    Results: Twenty-three studies compared individuals with BN-NP (N = 671) to individuals with BN-P (N 1795) and/or individuals with BED (N = 1921), two of which reported on course, 12 on comorbidity and none on treatment response-the indicators for validity and clinical utility. The differences found were mainly quantitative rather than qualitative, suggesting a gradual difference in severity from BN-P (most severe) through BN-NP to BED (least severe).

    Discussion: None of the comparisons provided convincing evidence for the validity or utility of the BN-NP diagnosis. Three options for the position of BN-NP in DSM-V were suggested: (1) maintaining the BN-NP subtype, (2) dropping non-purging compensatory behavior as a criterion for BN, so that individuals currently designated as having BN-NP would be designated as having BED, and (3) including BN-NP in a broad BN category. (C) 2009 American Psychiatric Association.

    Original languageEnglish
    Pages (from-to)595-602
    Number of pages8
    JournalInternational journal of eating disorders
    Volume42
    Issue number7
    DOIs
    Publication statusPublished - Nov-2009

    Keywords

    • bulimia nervosa
    • classification
    • BINGE-EATING DISORDER
    • COMMUNITY SAMPLE
    • SUICIDE ATTEMPTS
    • WOMEN
    • CLASSIFICATION
    • COMORBIDITY
    • CRITERIA
    • DIETARY

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