The classification of bulimic eating disorders: a community-based cluster analysis study

There is controversy over how best to classify eating disorders in which there is recurrent binge eating. Many patients with recurrent binge eating do not meet diagnostic criteria for other of the two established eating disorders, anorexia nervosa or bulimia nervosa. The present study was designed to derive an empirically based, and clinically meaningful, diagnostic scheme by identifying subgroups from among those with recurrent binge eating, testing the validity of these subgroups and comparing their predictive validity with that of the DSM-IV scheme. A general population sample of 250 young women with recurrent binge eating was recruited using a two-stage design. Four subgroups among the sample were identified using a Ward's cluster analysis. The first subgroup had either objective or subjective bulimic episodes and vomiting or laxative misuse; the second had objective bulimic episodes and low levels of vomiting or laxative misuse; the third had subjective bulimic episodes and low levels of vomiting or laxative misuse; and the fourth was heterogeneous in character. This cluster solution was robust to replication. It had good descriptive and predictive validity and partial construct validity. The results support the concept of bulimia nervosa and its division into purging and non-purging subtypes. They also suggest a possible new binge eating syndrome. Binge eating disorder, listed as an example of Eating Disorder Not Otherwise Specified within DSM-IV, did not emerge from the cluster analysis.

[1]  P. Hay,et al.  Eating disorder patient referrals from a population region 1977–1986 , 1991, Psychological Medicine.

[2]  S. Yanovski.  Binge eating disorder: current knowledge and future directions. , 1993, Obesity research.

[3]  L. Singer,et al.  Atypical eating disorders in young children , 1989 .

[4]  C. Fairburn,et al.  The Eating Disorders Examination , 1993 .

[5]  L. Atkinson,et al.  A replicated cluster solution in a heterogeneous psychiatric population. , 1986, Journal of clinical psychology.

[6]  C. Fairburn,et al.  Evaluation of a new instrument for the detection of eating disorders in community samples , 1992, Psychiatry Research.

[7]  J. H. Ward.  Hierarchical Grouping to Optimize an Objective Function , 1963 .

[8]  P. Cooper,et al.  Subclinical versus formal eating disorders: Differentiating psychological features , 1990 .

[9]  M. First,et al.  The Structured Clinical Interview for DSM-III-R (SCID). I: History, rationale, and description. , 1992, Archives of general psychiatry.

[10]  C. Fairburn,et al.  Binge eating: nature, assessment and treatment , 1993 .

[11]  T. Wadden,et al.  Binge eating disorder: its further validation in a multisite study. , 1993, The International journal of eating disorders.

[12]  Susan ZelitchYanovski.  Binge eating disorder: current knowledge and future directions. , 1993, Obesity research.

[13]  J. Garrow,et al.  Obesity and related diseases , 1988 .

[14]  John Gormally,et al.  The assessment of binge eating severity among obese persons. , 1982, Addictive behaviors.

[15]  Great Britain. Foreign Office.,et al.  Classification of occupations , 1960 .

[16]  R. Wing,et al.  Binge eating and dietary restraint in obese patients. , 1985, Addictive behaviors.

[17]  Binge eating disorder: reliability and validity of a new diagnostic category. , 1994 .

[18]  Brian Everitt,et al.  Statistical Methods for Medical Investigations , 1990 .

[19]  T. Wadden,et al.  Binge eating disorder: A multisite field trial of the diagnostic criteria , 1992 .

[20]  R. Palmer,et al.  Eating attitudes and disorder in young women: a general practice based survey , 1986, Psychological Medicine.

[21]  D. Gath,et al.  Evaluation of a Modified Self-Report Measure of Social Adjustment , 1982, British Journal of Psychiatry.

[22]  H. Leitenberg,et al.  Validity studies of the eating disorder examination , 1990 .

[23]  P. A. Norman,et al.  Bias and bulimia nervosa: how typical are clinic cases? , 1996, The American journal of psychiatry.

[24]  D. Williamson,et al.  Psychopathology associated with bulimia, binge eating, and obesity , 1988 .

[25]  K. Eldredge,et al.  Frequency of binge eating in bulimic patients : diagnostic validity , 1991 .

[26]  W. Agras,et al.  Binge eating and outcome of behavioral treatment of obesity: a preliminary report. , 1984, Behaviour research and therapy.

[27]  W. Agras,et al.  Obesity, binge eating and psychopathology: are they related? , 1994, The International journal of eating disorders.

[28]  P J Cooper,et al.  The Clinical Features of Bulimia Nervosa , 1984, British Journal of Psychiatry.

[29]  G. Wilson.  Assessment of binge eating. , 1993 .

[30]  G. Hynd,et al.  Child psychopathology : diagnostic criteria and clinical assessment , 1991 .

[31]  R R Wing,et al.  Obese binge eaters: affect, cognitions, and response to behavioural weight control. , 1988, Journal of consulting and clinical psychology.

[32]  M. King.  Eating disorders in a general practice population. Prevalence, characteristics and follow-up at 12 to 18 months. , 1989, Psychological medicine. Monograph supplement.

[33]  D. Yurgelun-Todd,et al.  Bulimia in Obese Individuals: Relationship to Normal‐Weight Bulimia , 1988, The Journal of nervous and mental disease.

[34]  T. Wadden,et al.  Response of obese binge eaters to treatment by behavior therapy combined with very low calorie diet. , 1992, Journal of consulting and clinical psychology.

[35]  C. Fairburn,et al.  The eating disorder examination: A semi‐structured interview for the assessment of the specific psychopathology of eating disorders , 1987 .

[36]  D. Goldberg,et al.  The validity of diagnostic systems for common mental disorders: a comparison between the ID-CATEGO and the DSM-III systems , 1990, Psychological Medicine.

[37]  D. Laporte.  Treatment response in obese binge eaters: preliminary results using a very low calorie diet (VLCD) and behavior therapy. , 1992, Addictive behaviors.

[38]  P. Beumont,et al.  Measuring the Specific Psychopathology of Eating Disorder Patients , 1993, The Australian and New Zealand journal of psychiatry.

[39]  G. Wilson,et al.  Assessment of binge eating in obese patients. , 1993, The International journal of eating disorders.

[40]  T. Wadden,et al.  Metabolic, anthropometric, and psychological characteristics of obese binge eaters. , 1993, The International journal of eating disorders.

[41]  M. Fichter,et al.  Recurrent overeating: an empirical comparison of binge eating disorder, bulimia nervosa, and obesity. , 1993, The International journal of eating disorders.

[42]  B. Everitt,et al.  Applied Multivariate Data Analysis. , 1993 .

[43]  C. Fairburn,et al.  Assessment of eating disorders: interview or self-report questionnaire? , 1994, The International journal of eating disorders.

[44]  G. Welch,et al.  Patient subgrouping in anorexia nervosa using psychologically‐based classification , 1990, International Journal of Eating Disorders.

[45]  Marsha D. Marcus,et al.  Psychiatric disorders among obese binge eaters. , 1990 .

[46]  M. de Zwaan,et al.  Psychopathology in subgroups of obese women with and without binge eating disorder. , 1994, Comprehensive psychiatry.

[47]  R R Wing,et al.  A double-blind, placebo-controlled trial of fluoxetine plus behavior modification in the treatment of obese binge-eaters and non-binge-eaters. , 1990, The American journal of psychiatry.

[48]  L. Derogatis,et al.  The Brief Symptom Inventory: an introductory report , 1983, Psychological Medicine.

[49]  K. Brownell,et al.  Handbook of Eating Disorders: Physiology, Psychology, and Treatment of Obesity, Anorexia, and Bulimia , 1986 .

[50]  P J Cooper,et al.  The Validity of the Eating Disorder Examination and its Subscales , 1989, British Journal of Psychiatry.

[51]  C. Fairburn,et al.  What is meant by the term "binge"? , 1992, The American journal of psychiatry.

[52]  P. Robson,et al.  Development of a new self-report questionnaire to measure self esteem , 1989, Psychological Medicine.

[53]  W. Stewart Agras,et al.  Binge eating in females: A population-based investigation† , 1992 .

[54]  M. de Zwaan,et al.  Binge eating in overweight women. , 1992, Comprehensive psychiatry.

[55]  G. Wilson,et al.  Assessment of bulimia nervosa: An evaluation of the eating disorders examination , 1989 .

[56]  James E Mitchell,et al.  A follow-up study of patients with bulimia , 1986 .

[57]  C. Fairburn,et al.  The classification of recurrent overeating: the "binge eating disorder" proposal. , 1993, The International journal of eating disorders.