Impairments among DSM-5 eating disorders: A systematic review and multilevel meta-analysis

Previous research revealed that people who did not meet full DSM-IV criteria for anorexia nervosa (AN), bulimia nervosa (BN), or binge-eating disorder (BED) but met criteria for eating disorder not otherwise specified (EDNOS) display high levels of psychiatric and physical morbidity commensurate with full criteria eating dis-orders. The DSM-5 introduced significant changes to eating disorder diagnostic criteria, so the present study aimed to determine whether the revised diagnostic criteria better distinguish between full criteria eating dis-orders, and other specified feeding or eating disorder (OSFED) and unspecified feeding or eating disorder (UFED). We present a series of meta-analyses comparing eating pathology, general psychopathology, and physical health impairments among those with AN, BN, and BED, compared to those with OSFED or UFED (n = 69 eligible studies). Results showed significantly more eating pathology in OSFED compared to AN, no difference in general psychopathology, and greater physical health impairments in AN. BN had greater eating pathology and general psychopathology than OSFED, but OSFED showed more physical health impairments. No differences were found between BN and purging disorder or low-frequency BN, or between BED and OSFED. Findings highlight the clinical severity of OSFED and suggest the DSM-5 criteria may not appropriately account for these presentations.

Automated summary

Previous research found that individuals who did not meet full criteria for AN, BN, or BED but met criteria for EDNOS displayed high levels of psychiatric and physical morbidity. The present study aimed to determine whether the revised DSM-5 criteria for eating disorders were better at distinguishing between full criteria eating disorders and OSFED and UFED. Meta-analyses comparing various measures were conducted, revealing that OSFED showed more eating pathology compared to AN, but no difference in general psychopathology. OSFED also had more physical health impairments. These findings suggest that the DSM-5 criteria may not adequately capture the clinical severity of OSFED.