Do<i>DSM-5</i>Eating Disorder Criteria Overpathologize Normative Eating Patterns among Individuals with Obesity?

<jats:p><jats:italic>Background.</jats:italic><jats:italic>DSM-5</jats:italic>revisions have been criticized in the popular press for overpathologizing normative eating patterns—particularly among individuals with obesity. To evaluate the evidence for this and other<jats:italic>DSM-5</jats:italic>critiques, we compared the point prevalence and interrater reliability of<jats:italic>DSM-IV</jats:italic>versus<jats:italic>DSM-5</jats:italic>eating disorders (EDs) among adults seeking weight-loss treatment.<jats:italic>Method.</jats:italic>Clinicians (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M1"><mml:mi>n</mml:mi><mml:mo>=</mml:mo><mml:mn>2</mml:mn></mml:math>) assigned<jats:italic>DSM-IV</jats:italic>and<jats:italic>DSM-5</jats:italic>ED diagnoses to 100 participants via routine clinical interview. Research assessors (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M2"><mml:mi>n</mml:mi><mml:mo>=</mml:mo><mml:mn>3</mml:mn></mml:math>) independently conferred ED diagnoses via Structured Clinical Interview for<jats:italic>DSM-IV</jats:italic>and a<jats:italic>DSM-5</jats:italic>checklist.<jats:italic>Results</jats:italic>. Research assessors diagnosed a similar proportion of participants with EDs under<jats:italic>DSM-IV</jats:italic>(29%) versus<jats:italic>DSM-5</jats:italic>(32%).<jats:italic>DSM-5</jats:italic>research diagnoses included binge eating disorder (9%), bulimia nervosa (2%), subthreshold binge eating disorder (5%), subthreshold bulimia nervosa (2%), purging disorder (1%), night eating syndrome (6%), and other (7%). Interrater reliability between clinicians and research assessors was “substantial” for both<jats:italic>DSM-IV</jats:italic>(<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M3"><mml:mrow><mml:mi>κ</mml:mi></mml:mrow></mml:math>= 0.64, 84% agreement) and<jats:italic>DSM-5</jats:italic>(<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M4"><mml:mrow><mml:mi>κ</mml:mi></mml:mrow></mml:math>= 0.63, 83% agreement).<jats:italic>Conclusion</jats:italic>.<jats:italic>DSM-5</jats:italic>ED criteria can be reliably applied in an obesity treatment setting and appear to yield an overall ED point prevalence comparable to<jats:italic>DSM-IV</jats:italic>.</jats:p>