Exploring clinician perspectives on the DSM-5 eating disorder severity ratings: a qualitative study

The DSM-5 introduced severity ratings in 2013 for anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED) based on BMI, compensatory behaviour frequency, and binge eating frequency, respectively. While several studies have assessed the validity of these ratings, little is known about their use in clinical practice. This study examined clinicians' use of DSM-5 severity ratings and their views on their clinical value. A sample of 38 clinicians (mean age = 38.5, 97.37% female) completed an online survey on the usage of DSM-5 severity ratings in clinical practice, and six participated in one-on-one interviews for further insights. Results showed that 60% of clinicians do not use these ratings. Qualitative findings obtained from both survey and one-on-one interviews found that clinicians perceive these ratings as invalidating, pathology-reinforcing, and lacking clinical relevance. However, some noted that these ratings can aid in triage and communication among clinicians in tertiary settings. This study highlights substantial concerns about the clinical utility of DSM-5 severity ratings for EDs, suggesting the need for a more comprehensive approach that considers broader psychological, medical, and cognitive indicators.