Problems Applying the DSM-IV Eating Disorders Diagnostic Criteria in a General Psychiatric Outpatient Practice

Objective: A substantial number of patients treated in specialized eating disorder programs fail to meet criteria for anorexia nervosa or bulimia nervosa, the 2 eating disorders with specified criteria in DSM-IV, and are diagnosed with eating disorder not otherwise specified (NOS). In a general psychiatric setting, where the severity of eating pathology is likely to be milder than in specialty programs, we predicted that most patients with disordered eating would fail to meet the full criteria for one of the DSM-IV eating disorders and instead would be diagnosed with eating disorder NOS.

Method: Two thousand five hundred psychiatric outpatients were interviewed with the Structured Clinical Interview for DSM-IV (SCID) upon presentation for treatment. The findings presented in this report were derived from patients interviewed from December 1995 to August 2006.

Results: Thirteen percent (N = 330) of the patients were diagnosed with a lifetime history of an eating disorder, 307 of whom received 1 diagnosis and 23 of whom were diagnosed with 2 disorders. Almost half (N = 164) of the disorders were present at the time of presentation, approximately one sixth (N = 60) were considered to be in partial remission, and slightly more than one third (N = 129) were past diagnoses. When binge-eating disorder was combined with the other forms of eating disorder NOS, as it is in DSM-IV, 90.2% (148/164) of the patients with a current eating disorder were diagnosed with eating disorder NOS.

Conclusions: The preponderance of eating-disordered patients in a general psychiatric setting were diagnosed with eating disorder NOS. This finding suggests that there is a problem with the clinical applicability of the diagnostic criteria in the DSM-IV eating disorder category.