Comparing operational definitions of DSM-5 anorexia nervosa for research contexts

  • Brown T
  • Holland L
  • Keel P
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OBJECTIVE: DSM-5 anorexia nervosa (AN) criteria include several changes that increase reliance on clinical judgment. However, research contexts require operational definitions that can be applied reliably and that demonstrate validity. The present study evaluated different operational definitions for DSM-5 AN.

METHOD: DSM-5 AN criteria were applied to diagnostic interview data from 364 women varying two features: threshold for determining low weight for Criterion A (body mass index [BMI]
RESULTS: All operational DSM-5 definitions produced higher lifetime frequency estimates than reported for DSM-IV AN, with a particularly large increase associated with the broadest definition. All definitions produced significant differences in comparison to controls on external validators that were associated with medium to large effect sizes. Only definitions that required a lower weight threshold or explicit endorsement of weight phobia demonstrated significant differences compared to OSFED on external validators, and these were of small effect size. The specific combination of BMI
DISCUSSION: To balance inclusivity, syndromal reliability, and validity, an operational definition for DSM-5 AN in research contexts should define low weight as BMI

Author-supplied keywords

  • DSM-5
  • anorexia nervosa
  • eating disorder
  • operational definitions

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  • Tiffany A. Brown

  • Lauren A. Holland

  • Pamela K. Keel

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