Validation of DSM-5 Severity Specifiers for Bulimia Nervosa and Binge Eating Disorder and an Alternative Specifier...

We examined the clinical validity of DSM-5 severity specifiers for bulimia nervosa (BN) and binge eating disorder (BED) in Korean outpatients.

Seven hundred ninety-nine outpatients with BN (n = 668; mean age = 23.7 years; 95% female; mean BMI = 20.54 kg/m²) or BED (n = 131; mean age = 26.1 years; 89% female; mean BMI = 25.07 kg/m²) were recruited from an eating disorders clinic. For BN, we assessed the validity of severity specifiers based on purging-type behaviours and overall compensatory behaviours. For BED, we examined the validity of the current severity specifier and an alternative specifier with an adjusted threshold based on the frequency distribution.

For BN, severity based on purging-type behaviours differentiated BMI and self-injury, whereas severity based on overall compensatory behaviours differentiated the level of weight suppression as well as eating-related and general psychopathology. In both classifications, increasing severity was linked to a greater likelihood of self-injury. For BED, 90% of patients were classified as mild-to-moderate using the current specifier. The adjusted index correlated more strongly with EDE-Q shape concerns and global scores than the current index.

The BN specifier differentiated clinical variables across severity groups. The adjusted BED specifier may better differentiate severity in the Korean population than the DSM-5 specifier, suggesting the potential benefit of cultural adjustments.