The validity and utility of subtyping bulimia nervosa

Authors

  • Daphne van Hoeken PhD,

    1. Department of Research, Parnassia Bavo Psychiatric Institute, The Hague, The Netherlands
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  • Wim Veling MD, PhD,

    1. Center for Early Psychosis, Parnassia Bavo Psychiatric Institute, The Hague, The Netherlands
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  • Sjoukje Sinke MA,

    1. Department of Eating Disorders and Obesity, PsyQ Haaglanden, The Hague, The Netherlands
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  • James E. Mitchell MD,

    1. Department of Clinical Neuroscience, Neuropsychiatric Research Institute, University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota
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  • Hans W. Hoek MD, PhD

    Corresponding author
    1. Department of Research, Parnassia Bavo Psychiatric Institute, The Hague, The Netherlands
    2. Department of Psychiatry, University of Groningen, University Medical Center Groningen, The Netherlands
    3. Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
    • Parnassia Bavo Psychiatric Institute, Kiwistraat 43, 2552 DH, The Hague, The Netherlands
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Abstract

Objective:

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.

Method:

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.

Results:

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).

Discussion:

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

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