Smink, Van Hoeken, Oldehinkel, and Hoek (2014), in a Dutch cohort study of adolescents identified 16 cases with DSM-5-defined AN for which they reported a statistically significant association between severity and detection and treatment rates but not with clinical recovery rates. ![]() ![]() For AN, no published studies have tested the DSM-5 severity specifier based on BMI using treatment seeking samples. Both studies, however, reported that the few statistically significant differences on clinical variables between severity levels reflected small effect sizes, and both studies provided stronger support for overvaluation of shape/weight as a specifier as it provided statistically significant and clinically meaningful (medium-to-large effect-sizes) information about severity. For binge eating disorder, two studies - one with a non-clinical ( Grilo, Ivezaj, & White, 2015b) and one with a clinical ( Grilo, Ivezaj, & White, 2015c) sample - converged in providing modest support for the DSM-5 severity rating based on the frequency of binge eating episodes. (2016), in a clinical sample of 214 patients with BN, found (i) few patients meeting the ‘extreme’ specifier (ii) some statistical differences between the ‘mild’ and other severity groups but not between the ‘moderate’ and ‘severe/extreme’ groups on measures of eating disorder pathology, psychological distress, and impairment and (ii) the few statistically significant findings reflected small effect sizes. (2015a) found that the DSM-5 BN severity groups differed on some associated features of eating-disorder psychopathology and depression but that the few statistically significant differences reflected small effect sizes. To date, for bulimia nervosa (BN), two studies - one performed with a non-clinical sample ( Grilo, Ivezaj, & White, 2015a) and one with a treatment-seeking clinical sample ( Jenkins, Luck, Cardy, & Staniford, 2016) - reported modest support for the DSM-5 severity rating based on the frequency of extreme weight compensatory behaviours. Although the level of severity may be increased by clinicians to reflect clinical symptoms, levels of disability, or the need for supervision, body mass index (BMI), intervals are used to define the minimum level of severity in the case of anorexia nervosa (AN) in the DSM-5 ( APA, 2013). The DSM-5 made a number of changes to the classification of eating disorders, which included severity specifiers intended to provide information regarding clinical severity for each of the diagnoses ( Regier, Kuhl, & Kupfer, 2013). In 2013, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders ( DSM-5) was published by the American Psychiatric Association ( APA, 2013).
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