Compensatory Eating Disorder: Disorder, Dimension, or Diagnostic Artefact?

Compensatory eating disorder (CED) is a newly proposed 'other specified feeding and eating disorder' that is characterised by recurrent non-purging compensatory behaviours, overvaluation of weight and shape, and the absence of objective binge eating, low weight, or recent significant weight loss. Although CED has been long documented in research, it remains unclear whether CED represents a distinct clinical diagnosis or a variant presentation of extant eating disorders. In this commentary, we situate CED within the broader eating disorders landscape and call for greater diagnostic clarity. We also provide five concrete future directions that can inform the appropriate classification of CED, including: (1) clarifying core diagnostic features of CED, (2) leveraging statistical models to inform CED classification, (3) establishing CED's longitudinal and prognostic validity, (4) incorporating clinician and patient perspectives on the adoption of CED diagnostic criteria, and (5) weighing risks and benefits of adding a new clinical diagnosis. These guidelines may help our field answer a novel research question that has implications for clinical practice: Is Compensatory Eating Disorder a missing diagnosis in the eating-disorder nomenclature or is it a misclassified one?