Abstract
BACKGROUND: Formation of Diagnostic and Statistical Manual of Mental Disorders (DSM) subcommittees combined with recently approved coding designations for bulimia nervosa (BN) in partial remission highlights the need to examine the validity of the threshold that distinguishes BN from other specified feeding or eating disorders (OSFED) BN of low frequency and/or limited duration (OSFED-BN). METHODS: Women (N = 344) who met DSM-5 criteria for BN (n = 153) or OSFED-BN (n = 118) or had no lifetime eating disorder symptoms (n = 78) completed assessments of height, weight, weight history, percent body fat, structured clinical interviews for DSM-5 disorders, suicidality, trauma, and treatment histories, and self-report questionnaires covering a range of validators related to eating disorders, psychological traits, and general psychopathology. Comparisons across groups tested the validity of OSFED-BN and whether prior history of DSM-5 BN impacted evidence of its clinical significance and distinctiveness. RESULTS: Lower frequency of binge eating was the primary reason for diagnosis of OSFED-BN vs. BN; more than 80% of those with OSFED-BN met or exceeded frequency and duration criteria for inappropriate compensatory behaviors. The current DSM-5 threshold distinguishing BN from its OSFED variant or from BN in partial remission produced few differences relative to several large differences observed for comparisons of these diagnostic groups and non-eating disorder controls. DISCUSSION: Despite being associated with distinct DSM-5 diagnostic codes, BN, BN in partial remission, and OSFED-BN appear to represent a single condition that may, at most, capture some dimensional differences in severity. Findings support lowering the current minimum frequency thresholds for diagnosing BN.