Do DSM-5 Eating Disorder Criteria Overpathologize Normative Eating Patterns among Individuals with Obesity?

Background.DSM-5revisions have been criticized in the popular press for overpathologizing normative eating patterns—particularly among individuals with obesity. To evaluate the evidence for this and otherDSM-5critiques, we compared the point prevalence and interrater reliability ofDSM-IVversusDSM-5eating disorders (EDs) among adults seeking weight-loss treatment.Method.Clinicians (n=2) assignedDSM-IVandDSM-5ED diagnoses to 100 participants via routine clinical interview. Research assessors (n=3) independently conferred ED diagnoses via Structured Clinical Interview forDSM-IVand aDSM-5checklist.Results. Research assessors diagnosed a similar proportion of participants with EDs underDSM-IV(29%) versusDSM-5(32%).DSM-5research 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 bothDSM-IV(κ= 0.64, 84% agreement) andDSM-5(κ= 0.63, 83% agreement).Conclusion.DSM-5ED criteria can be reliably applied in an obesity treatment setting and appear to yield an overall ED point prevalence comparable toDSM-IV.