Hostname: page-component-cd9895bd7-gbm5v Total loading time: 0 Render date: 2024-12-23T08:25:15.831Z Has data issue: false hasContentIssue false
  • English
  • Français

The classification of bulimic eating disorders: a community-based cluster analysis study

Published online by Cambridge University Press:  09 July 2009

P. J. Hay ,
C. G. Fairburn  and
H. A. Doll
P. J. Hay*
Affiliation:
Department of Psychiatry, University of Oxford
C. G. Fairburn
Affiliation:
Department of Psychiatry, University of Oxford
H. A. Doll
Affiliation:
Department of Psychiatry, University of Oxford
*
1Address for correspondence: Dr Phillipa Hay, Department of Psychiatry, University of Adelaide, Royal Adelaide Hospital, North Terrace, Adelaide, SA 5001, Australia
Get access Rights & Permissions [Opens in a new window]

Synopsis

There is controversy over how best to classify eating disorders in which there is recurrent binge eating. Many patients with recurrent binge eating do not meet diagnostic criteria for either of the two established eating disorders, anorexia nervosa or bulimia nervosa. The present study was designed to derive an empirically based, and clinically meaningful, diagnostic scheme by identifying subgroups from among those with recurrent binge eating, testing the validity of these subgroups and comparing their predictive validity with that of the DSM-IV scheme.

A general population sample of 250 young women with recurrent binge eating was recruited using a two-stage design. Four subgroups among the sample were identified using a Ward's cluster analysis. The first subgroup had either objective or subjective bulimic episodes and vomiting or laxative misuse; the second had objective bulimic episodes and low levels of vomiting or laxative misuse; the third had subjective bulimic episodes and low levels of vomiting or laxative misuse; and the fourth was heterogeneous in character. This cluster solution was robust to replication. It had good descriptive and predictive validity and partial construct validity.

The results support the concept of bulimia nervosa and its division into purging and non-purging subtypes. They also suggest a possible new binge eating syndrome. Binge eating disorder, listed as an example of Eating Disorder Not Otherwise Specified within DSM-IV, did not emerge from the cluster analysis.

Type
Original Articles
Information
Psychological Medicine , Volume 26 , Issue 4 , July 1996 , pp. 801 - 812
Copyright
Copyright © Cambridge University Press 1996

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn.American Psychiatric Association: Washington, DC.Google Scholar
Beglin, S. J. (1990). Eating Disorders in Young Adult Women. Ph.D. thesis, University of Oxford.Google Scholar
Beglin, S. J. & Fairburn, C. G. (1992 a). What is meant by the term ‘Binge’? American Journal of Psychiatry 149, 123–124.Google ScholarPubMed
Beglin, S. J. & Fairburn, C. G. (1992 b). Evaluation of a new instrument for the detection of eating disorders in community samples. Psychiatry Research 44, 191–201.CrossRefGoogle ScholarPubMed
Beumont, P. J. V., Kopec-Schrader, E. M., Talbot, P. & Touyz, S. W. (1993). Measuring the specific psychopathology of eating disorder patients. Australian and New Zealand Journal of Psychiatry 27, 506–511.CrossRefGoogle ScholarPubMed
Brody, M. L., Walsh, B. T. & Devlin, M. J. (1994). Binge eating disorder: reliability and validity of a new diagnostic category. Journal of Consulting and Clinical Psychology 62. 381–386.CrossRefGoogle ScholarPubMed
Bruce, B. & Agras, W. S. (1992). Binge eating in females: a population-based investigation. International Journal of Eating Disorders 12, 365–373.3.0.CO;2-M>CrossRefGoogle Scholar
Bunnell, D. W., Shenker, I. R., Nussbaun, M. P., Jacobson, M. S. & Cooper, P. J. (1990). Subclinical versus formal eating disorders: differentiating psychological features. International Journal of Eating Disorders 9. 357–362.3.0.CO;2-Z>CrossRefGoogle Scholar
Clinton, D. N. & Glant, R. (1992). The eating disorders spectrum of DSM-III-R. Clinical features and psychosocial concomitants of 86 consecutive cases from a Swedish urban catchment area. Journal of Nervous and Mental Disease 180, 244–250.CrossRefGoogle ScholarPubMed
Cooper, P., Osborn, M., Gath, D. & Feggetter, G. (1982). Evaluation of a modified self-report measure of social adjustment. British Journal of Psychiatry 141, 68–75.CrossRefGoogle ScholarPubMed
Cooper, Z. & Fairburn, C. G. (1987). The Eating Disorder Examination: a semistructured interview for the assessment of the specific psychopathology of eating disorders. International Journal of Eating Disorders 6, 1–8.3.0.CO;2-9>CrossRefGoogle Scholar
Cooper, Z., Cooper, P. J. & Fairburn, C. G. (1989). The validity of the Eating Disorder Examination and its subscales. British Journal of Psychiatry 154, 807–812.CrossRefGoogle ScholarPubMed
Cyr, J. J., Atkinson, L. & Haley, G. A. (1986). A replicated cluster solution in a heterogenous psychiatric population. Journal of Clinical Psychology 42, 92–99.3.0.CO;2-2>CrossRefGoogle Scholar
Dansky, B. S. & Brewerton, T. D. (1996). The National Women's Study: relationship of crime victimization and PTSD to bulimia nervosa. International Journal of Eating Disorders (in the press).Google Scholar
Derogatis, L. R. & Melisaratos, N. (1983). The brief symptom inventory: an introductory report. Psychological Medicine 13, 595–605.CrossRefGoogle ScholarPubMed
de Zwaan, M., Nutzinger, D. O. & Schoenbeck, G. (1992). Binge eating in overweight women. Comprehensive Psychiatry 33, 256–261.CrossRefGoogle ScholarPubMed
Endicott, J., Andreason, N. & Spitzer, R. (1978). Family History – Research Diagnostic Criteria (FH-RDQ) 7/18/78. Biometrics Research. New York State Psychiatric Institute: New York.Google Scholar
Everitt, B. S. (1989). Statistical Methods for Medical Investigations. Oxford University Press: New York.Google Scholar
Everitt, B. S. & Dunn, G. (1991). Applied Multivariate Data Analysis. Edward Arnold: London.Google Scholar
Fairburn, C. G. & Beglin, S. J. (1995). The assessment of eating disorders: Interview or self-report questionnaire? International Journal of Eating Disorders 16, 363–370.3.0.CO;2-#>CrossRefGoogle Scholar
Fairburn, C. G. & Cooper, Z. (1993). The Eating Disorder Examination, (12th edn.). In Binge Eating: Nature, Assessment and Treatment (ed. Fairburn, C. G. and Wilson, G. T.), pp. 317–360. Guilford Press: New York.Google Scholar
Fairburn, C. G. & Walsh, B. T. (1995). Atypical eating disorders. In Comprehensive Textbook of Eating Disorders and Obesity (ed. Brownell, K. D. and Fairburn, C. G.), pp. 135–140. Guilford Press: New York.Google Scholar
Fairburn, C. G. & Wilson, G. T. (1993). Binge eating: definition and classification. In Binge Eating: Nature, Assessment and Treatment (ed. Fairburn, C. G. and Wilson, G. T.), pp. 3–14. Guilford Press: New York.Google Scholar
Fairburn, C. G., Cooper, Z. & Cooper, P. J. (1986). The clinical features and maintenance of bulimia nervosa. In Handbook of Eating Disorders: Physiology, Psychology and Treatment of Obesity, Anorexia and Bulimia (ed. Brownell, K. D. and Foreyt, J. P.), pp. 389–404. Basic Books: New York.Google Scholar
Fairburn, C. G., Welch, S. L. & Hay, P. J. (1993). The classification of recurrent overeating: the ‘binge eating disorder’ proposal. International Journal of Eating Disorders 13, 155–159.3.0.CO;2-T>CrossRefGoogle ScholarPubMed
Fairburn, C. G., Welch, S. L., Norman, P. A., O'Connor, M. E. & Doll, H. A. (1995). Bias and bulimia nervosa: how typical are clinic cases? American Journal of Psychiatry (in the press).Google Scholar
Fichter, M. M., Quadflieg, N. & Brandl, B. (1993). Recurrent overeating: An empirical comparison of binge eating disorder, bulimia nervosa, and obesity. International Journal of Eating Disorders 14, 1–16.3.0.CO;2-3>CrossRefGoogle ScholarPubMed
Garner, D. M., Shafer, C. L. & Rosen, L. W. (1991). Critical appraisal of the DSM-III-R diagnostic criteria for eating disorders. In Child Psychopathology: Diagnostic Criteria and Clinical Assessment (ed. Hooper, S. R., Hynd, G. W. and Mattison, R. E.), pp. 261–303. Erlbaum: Hillsdale, NJ.Google Scholar
Garrow, J. S. (1988). Obesity and Related Diseases. Churchill Livingstone: Edinburgh.Google Scholar
Gormally, J., Black, S., Daston, S. & Rardin, D. (1982). The assessment of binge-eating severity among obese persons. Addictive Behaviours 7, 47–55.CrossRefGoogle ScholarPubMed
Grayson, D., Bridges, K., Cook, D. & Goldberg, D. (1990). The validity of diagnostic systems for common mental disorders: a comparison between the ID-CATEGO and the DSM-III systems. Psychological Medicine 20, 209–218.CrossRefGoogle ScholarPubMed
Hall, A. & Hay, P. J. (1991). Eating disorder patient referrals form a population region 1977–1986. Psychological Medicine 21, 697–701.CrossRefGoogle Scholar
Hudson, J. I., Pope, H. G. Jr, Wurtman, J., Yurgelun-Todd, D., Mark, S. & Rosenthal, N. E. (1988). Bulimia in obese individuals: relationship to normal weight bulimia. Journal of Nervous and Mental Disease 176, 144–152.CrossRefGoogle ScholarPubMed
Keefe, P. H., Wyshogrod, D., Weinberger, E. & Agras, W. S. (1984). Binge eating and outcome of behavioural treatment of obesity: a preliminary report. Behavior Research and Therapy 22, 319–321.CrossRefGoogle ScholarPubMed
King, M. B. (1989). Eating Disorders in a General Practice Population. Prevalence, Characteristics and Follow-up at 12 to 18 months. Psychological Medicine Monograph Supplement 14, Cambridge University Press: Cambridge.Google Scholar
La Porte, D. J. (1992). Treatment response in obese binge eaters: Preliminary results using a very low caloric diet (VLCD) and behaviour therapy. Addictive Behaviors 17, 247–257.CrossRefGoogle Scholar
Marcus, M. D., Wing, R. R. & Lamparski, D. M. (1985). Binge eating and dietary restraint in obese patients. Addictive Behaviors 10, 163–168.CrossRefGoogle ScholarPubMed
Marcus, M. D., Wing, R. R. & Hopkins, J. (1988). Obese binge eaters: affect, cognitions, and response to behavioral weight control. Journal of Consulting and Clinical Psychology 3, 433–439.CrossRefGoogle Scholar
Marcus, M. D., Wing, R. R., Ewing, L., Kern, E., Gooding, W. & McDermott, M. (1990 a). Psychiatric disorders among obese binge eaters. International Journal of Eating Disorders 9, 69–77.3.0.CO;2-K>CrossRefGoogle Scholar
Marcus, M. D., Wing, R. R., Ewing, L., Kern, E., McDermott, M. & Gooding, W. (1990 b). A double-blind placebo-controlled trial of fluoxetine in the treatment of obese binge eaters and non-binge-eaters. American Journal of Psychiatry 147, 876–881.Google ScholarPubMed
Meadows, G. N., Palmer, R. L., Newball, E. U. M. & Kenrick, J. M. T. (1986). Eating attitudes and disorder in young women: a general practice based survey. Psychological Medicine 16, 351–357.CrossRefGoogle ScholarPubMed
Mitchell, J. E., Davis, L., Goff, G. & Pyle, R. (1986). A follow-up study of patients with bulimia. International Journal of Eating Disorders 5, 441–450.3.0.CO;2-J>CrossRefGoogle Scholar
Office of the Population of Census and Surveys (1980). Classification of Occupations and Coding Index. Her Majesty's Stationery Office: London.Google Scholar
Office of Health Economics (1987). Compendium of Health Statistics. Office of Health Economics: London.Google Scholar
Prather, R. C. & Williamson, D. A. (1988). Psychopathology associated with bulimia, binge eating, and obesity. International Journal of Eating Disorders 7, 177–184.3.0.CO;2-1>CrossRefGoogle Scholar
Robson, P. J. (1989). Development of a new self-report questionnaire to measure self-esteem. Psychological Medicine 19, 513–518.CrossRefGoogle ScholarPubMed
Rosen, J. C., Vara, L., Wendt, S. & Leitenberg, H. (1990). Validity studies of the Eating Disorder Examination. International Journal of Eating Disorders 9, 519–528.3.0.CO;2-K>CrossRefGoogle Scholar
Statistical Analysis System (SAS) Institute Inc. (1989). SAS/Stat User's Guide Version 6, 4th edn, Vol. 1 and 2. SAS Institute Inc.: Cary, North Carolina.Google Scholar
Specker, S., de Zwaan, M., Raymond, N. & Mitchell, J. (1994). Psychopathology in subgroups of obese women with and without binge eating disorder. Comprehensive Psychiatry 35, 185–190.CrossRefGoogle ScholarPubMed
Spitzer, R. L., Devlin, M., Walsh, B. T., Hasin, D., Wing, R., Marcus, M., Stunkard, A., Wadden, T., Yanovski, S., Agras, S., Mitchell, J. & Nonas, C. (1992 a). Binge eating disorders multisite field trial of the diagnostic criteria. International Journal of Eating Disorders 11, 191–203.3.0.CO;2-S>CrossRefGoogle Scholar
Spitzer, R. L., Williams, J. B. W., Gibbon, M. & First, M. B. (1992 b). The structured clinical interview for DSM-III-R (SCID) I. History, rationale, and description. Archives of General Psychiatry 49, 624–629.CrossRefGoogle ScholarPubMed
Spitzer, R. L., Yanovski, S., Wadden, T., Wing, R., Stunkard, A., Devlin, M., Mitchell, J., Hasin, D. & Horne, R. L. (1993). Binge eating disorder: its further validation in a multisite study. International Journal of Eating Disorders 13, 137–153.3.0.CO;2-#>CrossRefGoogle Scholar
Telch, C. F. & Agras, W. S. (1994). Obesity, binge eating and psychopathology: are they related? International Journal of Eating Disorders 15, 53–61.3.0.CO;2-0>CrossRefGoogle ScholarPubMed
Wadden, T. A., Foster, G. D. & Letizia, K. A. (1992). Response of obese binge eaters to treatment by very low calorie diet combined with behavior therapy. Journal of Consulting and Clinical Psychology 60, 808–811.CrossRefGoogle ScholarPubMed
Wadden, T. A., Foster, G. D., Letizia, K. A. & Wilk, J. E. (1993). Metabolic, anthropometric, and psychological characteristics of obese binge eaters. International Journal of Eating Disorders 14, 17–25.3.0.CO;2-L>CrossRefGoogle ScholarPubMed
Ward, J. H. (1963). Hierarchical grouping to optimize an objective function. Journal of the American Statistical Association 58, 236–244.CrossRefGoogle Scholar
Welch, G., Hall, A. & Renner, R. (1990). Patient subgrouping in anorexia nervosa using a psychologically-based classification. International Journal of Eating Disorders 9, 311–322.3.0.CO;2-#>CrossRefGoogle Scholar
Wilson, G. T.Assessment of binge eating. (1993). In Binge Eating: Nature, Assessment and Treatment (ed. Fairburn, C. G. and Wilson, G. T.), pp. 227–249. Guilford Press: New York.Google Scholar
Wilson, G. T. & Smith, D. (1989). Assessment of bulimia nervosa: an evaluation of the Eating Disorder Examination. International Journal of Eating Disorders 8, 173–179.3.0.CO;2-V>CrossRefGoogle Scholar
Wilson, G. T. & Eldredge, K. (1991). Frequency of binge eating in bulimia nervosa: diagnostic validity. International Journal of Eating Disorders 10, 557–561.3.0.CO;2-X>CrossRefGoogle Scholar
Wilson, G. T., Nonas, C. A. & Rosenblum, G. D. (1993). Assessment of binge eating in obese patients. International Journal of Eating Disorders 13, 25–33.3.0.CO;2-T>CrossRefGoogle ScholarPubMed
World Health Organization (1992). The ICD-10 Classification of Mental and Behavioural Disorders. Clinical Descriptions and Diagnostic Guidelines. World Health Organization: Geneva.Google Scholar
Yanovski, S. Z. (1993). Binge eating disorder: current knowledge and future directions. Obesity Research 4, 306–324.Google Scholar