DSM-IV Criteria: On-Target for Youth?

According to three researchers at the University of Minnesota, a disturbing number of teens report weight concerns and symptoms of disordered eating that are clinically severe but do not meet the current Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) criteria for an eating disorder (Int J Eat Disord 2007;40:409). The researchers contend that the DSM-IV classifications are clinically helpful but may be too complicated for use in epidemiologic studies, particularly studies of younger populations.

According to Diann M. Ackard, PhD and others, results of a recent study of 4,746 public middle school and high school students showed that more than one-third of the girls and nearly one-fourth of the boys said that body shape and weight significantly influences the way they view themselves and some also reported disordered eating behaviors. The students were participants in the Growing Up Today Study (GUTS), which used self-report questionnaires to evaluate eating concerns, height, weight, and other areas of interest.

Disturbing symptoms reported

While very few of the teens met criteria for a diagnosable eating disorder, many endorsed symptoms that should call for intervention to avoid development of an eating disorder and associated complications. More than a fourth of the girls and a fifth of the boys endorsed questions about body image perception disturbances without engaging in any disordered eating behavior. Of similar concern, one-tenth of the females and one-eighth of males in the GUTS study used recurrent compensatory behaviors to control their weight, such as self-induced vomiting, laxative use, and/or excessive exercise.

The authors also stressed the need for changes in the criteria for eating disorders not otherwise specified (EDNOS). In their study, very few of the teens met criteria for anorexia nervosa (1 student) or bulimia nervosa (12), nearly three times as students met criteria for binge eating disorder (BED, 53 students), and many more endorsed individual eating disorders criteria without meeting the full threshold diagnoses.