Assessing Severity in Anorexia Nervosa Using Alternative Criteria to the DSM-5 in a Cross-Sectional Study

Area of Science:

• Psychiatry
• Clinical Psychology
• Eating Disorders Research

Background:

• The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) classification for anorexia nervosa (AN) severity has limitations.
• Alternative severity classifications, including overvaluation of weight and shape (OWS) and drive for thinness (DT), require further investigation.

Purpose of the Study:

• To compare the clinical utility of OWS, DT, and their combination (OWS-DT) against DSM-5 severity classifications for AN.
• To evaluate these classifications based on associations with clinical and functional severity indicators.

Main Methods:

• 312 AN outpatients were classified using DSM-5 criteria, OWS, DT, and OWS-DT.
• Classifications were assessed for associations with psychiatric comorbidities, psychopathology (Eating Disorder Examination Questionnaire, Eating Disorder Inventory), functional impairment (Eating Disorders Quality-of-Life Questionnaire, Work-and-Social Adjustment Scale), and biological markers.

Main Results:

• OWS and DT were strongly associated with increased psychiatric comorbidities, psychopathology, and functional impairment.
• Severity increased across OWS-DT groups (neither, OWS only, OWS and DT), with DT rarely occurring without OWS.
• DSM-5 classification showed limited clinical relevance, primarily reflecting energy intake restriction; no significant differences were found for biological markers across classifications.

Conclusions:

• DSM-5 severity criteria alone provide limited clinical utility for AN.
• OWS and DT, particularly their combination, demonstrate clearer clinical utility in identifying AN severity.
• A stepwise assessment of OWS followed by DT may be the most effective approach for capturing AN severity in clinical practice.