Diagnostic efficiency of DSM–IV indicators for binge eating episodes.

Since the inclusion of binge eating disorder (BED) in Appendix B of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) as a research criteria set in need of further study, numerous studies have provided empirical support for various aspects of the validity of this diagnostic construct (e.g., (Grilo et al., 2008; Grilo, Masheb, & White, 2010). In their critical review of the literature, Striegel-Moore and Franko (2008) concluded that sufficient empirical evidence exists supporting BED as a distinct and formal diagnosis in the DSM-5. BED is defined by recurrent binge eating without inappropriate weight-control behaviors that characterize bulimia nervosa (BN). Binge eating is defined as overeating large quantities of food during which a subjective loss of control is experienced. The research criteria include a set of five “indicators of impaired control” provided with the goal of assisting in the determination of whether loss of control during overeating (i.e., binge eating) exists. These indicators were originally generated by experts based on clinical experience, but they have yet to be empirically evaluated or validated. In preparation for the DSM-5, various groups have examined aspects of the research criteria for BED (Striegel-Moore & Franko, 2008) including for example the frequency and duration stipulation requirements for binge eating (Wilson & Sysko, 2009). However, no studies have been reported testing the diagnostic utility of the proposed “indicators of impaired control.” Currently, the DSM-IV research criteria set for BED, but not for BN, requires the presence of at least 3 of 5 “indicators of impaired control”: eating until uncomfortably full, eating when not hungry, eating more rapidly than usual, eating in secret, and feeling disgust, guilt, or depression after the episode. Diagnostic efficiency refers to the extent to which diagnostic criteria are able to discriminate persons with a given diagnosis from those without that diagnosis, as determined by the application of conditional probabilities (Grilo, Becker, Anez, & McGlashan, 2004; Grilo, McGlashan et al., 2001). Such analyses can be particularly relevant to the refinement or revision of criterion sets in classification or diagnostic schemes such as the DSM. The use of diagnostic efficiency has contributed to the refinement of some behavioral and diagnostic constructs (e.g., (Faraone, Biederman, Sprich-Buckminster, Chen, & Tsuang, 1993; Grilo et al., 2004; Milich, Widiger, & Landau, 1987; Waldman & Lilienfeld, 1991)), and such data previously influenced, to some degree, some DSM–IV Work Groups (Gunderson, Zanarini, & Kisiel, 1991). Such analyses also have considerable practical application for clinicians in terms of assisting them during evaluations and diagnostic decision making. The present study examined the diagnostic efficiency of the “indicators for impaired control” proposed as part of the research criteria for BED in the DSM-IV. We used the internet to recruit participants for an on-line survey rather than a treatment-seeking or clinic-based sample. The survey included direct questions for each of the indicators and these criteria were examined in three diagnostic groups (BED, BN, and combined BED+BN). The three diagnostic groups were created using convergent data from established assessment measures for eating disorder psychopathology. Diagnostic efficiency statistics were calculated for the indicators separately for the BED, BN, and BN+BED groups; these analyses involved relevant data from “controls” comprising non-binge-eating and non-purging participants.