Classification of Feeding and Eating Disorders: Review of Evidence and Proposals for ICD-11.

Classification of feeding and eating disorders: review of evidence and proposals for ICD-11.

Filed under: Eating Disorders

World Psychiatry. 2012 Jun; 11(2): 80-92
Uher R, Rutter M

Current classification of eating disorders is failing to classify most clinical presentations; ignores continuities between child, adolescent and adult manifestations; and requires frequent changes of diagnosis to accommodate the natural course of these disorders. The classification is divorced from clinical practice, and investigators of clinical trials have felt compelled to introduce unsystematic modifications. Classification of feeding and eating disorders in ICD-11 requires substantial changes to remediate the shortcomings. We review evidence on the developmental and cross-cultural differences and continuities, course and distinctive features of feeding and eating disorders. We make the following recommendations: a) feeding and eating disorders should be merged into a single grouping with categories applicable across age groups; b) the category of anorexia nervosa should be broadened through dropping the requirement for amenorrhoea, extending the weight criterion to any significant underweight, and extending the cognitive criterion to include developmentally and culturally relevant presentations; c) a severity qualifier “with dangerously low body weight” should distinguish the severe cases of anorexia nervosa that carry the riskiest prognosis; d) bulimia nervosa should be extended to include subjective binge eating; e) binge eating disorder should be included as a specific category defined by subjective or objective binge eating in the absence of regular compensatory behaviour; f) combined eating disorder should classify subjects who sequentially or concurrently fulfil criteria for both anorexia and bulimia nervosa; g) avoidant/restrictive food intake disorder should classify restricted food intake in children or adults that is not accompanied by body weight and shape related psychopathology; h) a uniform minimum duration criterion of four weeks should apply.
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Pharmacological management of binge eating disorder: current and emerging treatment options.

Filed under: Eating Disorders

Ther Clin Risk Manag. 2012; 8: 219-41
McElroy SL, Guerdjikova AI, Mori N, O’Melia AM

Growing evidence suggests that pharmacotherapy may be beneficial for some patients with binge eating disorder (BED), an eating disorder characterized by repetitive episodes of uncontrollable consumption of abnormally large amounts of food without inappropriate weight loss behaviors. In this paper, we provide a brief overview of BED and review the rationales and data supporting the effectiveness of specific medications or medication classes in treating patients with BED. We conclude by summarizing these data, discussing the role of pharmacotherapy in the BED treatment armamentarium, and suggesting future areas for research.
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Cultural Adaptation of the Difficulties in Emotion Regulation Scale: Reliability and Validity of an Italian Version.

Filed under: Eating Disorders

J Clin Psychol. 2012 May 31;
Giromini L, Velotti P, de Campora G, Bonalume L, Cesare Zavattini G

OBJECTIVE: The aim of this study was to evaluate the reliability and validity of an Italian version of the Difficulties in Emotion Regulation Scale (DERS; Gratz & Roemer, 2004). METHOD: Three studies were completed. First, factorial structure, internal consistency, and concurrent validity of our Italian version of the DERS were examined with a sample of 323 students (77% female; mean age 25.6). Second, test-retest analyses were completed using a different sample of 61 students (80% female; mean age 24.7). Third, the scores produced by a small clinical sample of participants (N = 38; mean age = 24.2) affected by anorexia, binge eating disorder, or bulimia were compared to those of an age-matched, nonclinical female sample (N = 38; mean age = 24.7). RESULTS: The factorial structure replicated quite well the six-factor structure proposed by Gratz and Roemer. The internal consistency and test-retest reliability were adequate and comparable to previous findings. The validity was good, as indicated by both the concurrent validity analysis and the clinical-nonclinical sample comparison. CONCLUSIONS: These studies provide further support for the multidimensional model of emotion regulation postulated by Gratz and Roemer and strengthen the rationale for cross-cultural utilization of the DERS. © 2012 Wiley Periodicals, Inc. J. Clin. Psychol. 00:1-20, 2012.
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