Psychometric characteristics of DSM-5 eating disorder diagnostic criteria: support for a transdiagnostic approach

TL;DR

This study finds that eating disorder diagnoses share common factors, suggesting a more unified approach to diagnosis and treatment.

Contribution

The study provides the first comprehensive psychometric analysis of DSM-5 eating disorder criteria in adult patients.

Findings

Factor analysis of DSM-5 criteria revealed five key factors shared across eating disorder diagnoses.

Fear of weight gain and weight-based self-evaluation are common across all eating disorder categories.

Diagnostic efficiency statistics support a transdiagnostic model for eating disorders.

Abstract

This study is the first to comprehensively examine psychometric characteristics of the three main DSM-5 eating disorder (ED) diagnoses (Anorexia Nervosa (AN), Bulimia Nervosa (BN), Binge Eating Disorder (BED)) amongst adult ED patients. Data was collected via an online survey from 126 licensed therapists treating an adult with an ED. Therapists provided an ED DSM-5 diagnosis for a randomly selected patient, as well as endorsed the presence of symptoms from a list of DSM criteria. Criteria endorsement varied across both the entire sample and within diagnoses. Convergence and cohesion also varied within diagnoses. The first factor analysis for DSM-5 ED criteria yielded a five-factor solution for ED criteria accounted for 78.3% of variance: (1) Binge eating, (2) Compensatory and purging behaviors, (3) Shape/weight overvaluation, (4) Drive for thinness, and (5) Absence of binging and purging. Finally, diagnostic efficiency statistics were consistent with this factor model. Overall, our findings support a new, transdiagnostic model with fear of weight gain and weight being main aspects of self-evaluation as common underlying factors amongst all EDs.

The online version contains supplementary material available at 10.1186/s40337-025-01512-7.

The diagnosis of eating disorders (EDs) is currently separated by distinct categories. However, our analysis argues for more commonality across these different categories. For example, fear of weight gain and weight influencing one’s self-evaluation appears to be common across all categories. Certain diagnoses, including anorexia and bulimia, may benefit from more flexible descriptions, including a less strict weight requirement for the former and a less strict frequency of bingeing/purging requirement for the latter. In all, there are similarities amongst different ED categories currently viewed as distinct from one another, especially between anorexia and bulimia.

The online version contains supplementary material available at 10.1186/s40337-025-01512-7.