Special Section Review Article/Eating Disorders in DSM-V: Review of Existing Literature (Part 1)
The validity and utility of subtyping bulimia nervosa
Article first published online: 20 JUL 2009
Copyright © 2009 American Psychiatric Association. This Article is being co-published by the International Journal of Eating Disorders and the American Psychiatric Association.
International Journal of Eating Disorders
Volume 42, Issue 7, pages 595–602, November 2009
How to Cite
van Hoeken, D., Veling, W., Sinke, S., Mitchell, J. E., Hoek, H. W. (2009), The validity and utility of subtyping bulimia nervosa. Int. J. Eat. Disord., 42: 595–602. doi: 10.1002/eat.20724
- Issue published online: 16 OCT 2009
- Article first published online: 20 JUL 2009
- Manuscript Accepted: 9 JUN 2009
- bulimia nervosa;
To review the evidence for the validity and utility of subtyping bulimia nervosa (BN) into a purging (BN-P) and a nonpurging subtype (BN-NP), and of distinguishing BN-NP from binge eating disorder (BED), by comparing course, complications, and treatment.
A literature search of psychiatry databases for studies published in peer-reviewed journals that used the DSM-definitions of BN and BED, and included both individuals with BN-NP and individuals with BN-P and/or BED.
Twenty-three studies compared individuals with BN-NP (N = 671) to individuals with BN-P (N = 1795) and/or individuals with BED (N = 1921), two of which reported on course, 12 on comorbidity and none on treatment response—the indicators for validity and clinical utility. The differences found were mainly quantitative rather than qualitative, suggesting a gradual difference in severity from BN-P (most severe) through BN-NP to BED (least severe).
None of the comparisons provided convincing evidence for the validity or utility of the BN-NP diagnosis. Three options for the position of BN-NP in DSM-V were suggested: (1) maintaining the BN-NP subtype, (2) dropping nonpurging compensatory behavior as a criterion for BN, so that individuals currently designated as having BN-NP would be designated as having BED, and (3) including BN-NP in a broad BN category. © 2009 American Psychiatric Association. Int J Eat Disord 2009