An Investigation of the Clinical Utility of the Proposed ICD-11 and DSM-5 Diagnostic Schemes for Eating Disorders Characterized by Recurrent Binge Eating in People with a High BMI
2. Materials and Methods
- Mini International Neuropsychiatric Interview (MINI) [18,19]: this structured interview is reliable and validated for diagnoses according to the DSM-5 . The MINI version 5  assessing DSM-IV diagnoses  has been translated into Portuguese. Thus, the MINI-5 was used in this study, with modifications to coding according to DSM-5 criteria, as in the MINI-7 .
- Eating Disorder Examination (EDE) Edition 17.0D : the EDE is a semi-structured interview. It assesses eating disorder features. It has four subscales measuring levels of dietary restraint, eating, shape and weight concerns. The global score is a mean of subscale scores. In this study, the new Version 17.0D item scoring, that included “being in control” as a reason for the behavior or cognition, was used. EDE version 16.0  has been translated to Brazilian/Portuguese by researchers from the Universidade Federal do Rio de Janeiro (Silvia Freitas, José Carlos Appolinario), by authors of this paper (MAP, AC) and by an eating disorder specialist and member of the Eating Disorder Program (Christina Morgan—CM). A certified translator then back translated it into English. An author of the EDE (O’Connor, M) approved the final version. The translated EDE interrater reliability and concurrent validity were tested and found to be satisfactory. In the validity study, the diagnoses were made according to the eating disorder module of the SCID-I/P interview  (Portuguese version) . Diagnostic agreement between the Portuguese EDE version 16.0 and the SCID I/P (both testing DSM-IV diagnoses) was found to be moderate (Kappa = 0.66; n = 149), with a Cronbach α of 0.91 (95% CI: 0.88 0.92) (unpublished data provided by AC). For the purpose of the present study, small adjustments were made by MAP, so that the Portuguese version used was consistent with the 17th version of the EDE , in order to derive DSM-5 categories. Cronbach α in this sample was 0.66, n = 107.
- Binge Eating Scale (BES) : the BES is a 16-item self-report instrument that was translated and validated in a Brazilian sample . The BES measures frequency and severity of binge eating. The Brazilian version has undergone psychometric assessment and has a cut-off point for normality of 17 for the screening of eating disorders in obese individuals seeking treatment for weight loss. Cronbach α in this sample was 0.83, n = 106.
- Loss of Control over Eating Scale (LOCES) . This 24-item self-report scale measures loss of control during binge eating episodes in the last 4 weeks, with a mean score of 1.70 (SD = 5.72). It has been translated into Brazilian/Portuguese. This translated version has adequate psychometric properties (factor analysis and convergent validity) . Cronbach α in this sample was 0.91, n = 107.
- Depression, Anxiety and Stress Scale (DASS-21) [30,31] was used in its translated and validated Brazilian/Portuguese version . The DASS is a 21-item self-report instrument that measures the presence and severity of depressive symptoms, anxiety and stress with a cut-off point for normality of 9 for depression, 7 for anxiety and 14 for stress. Cronbach α in this sample was 0.92, and for each subscale was: stress 0.85, depression 0.89, and anxiety 0.77, n = 107.
- Health-related quality of life was assessed with the 12-item Short Form Health Survey (SF-12) : a self-report questionnaire. It has two scales, the Physical Health Component Summary scale (PCS) and Mental Health Component Summary scale (MCS). The English language version has sound psychometric properties and it has been translated into Brazilian/Portuguese . Cronbach α in this sample was 0.79, n = 106.
- Disability was asked with a question closely similar to the ‘days out of role’ questions employed in the Australian National Survey of Mental Health and Well-Being . Participants were asked to write for the past 4 weeks a response to, “on how many days, if any, were you unable to complete your work, study or household responsibilities because of any problem with your (physical or emotional) health”? An author (MAP) translated this text.
2.3. Statistical Analyses
Conflicts of Interest
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|Clinical Features||Bulimia Nervosa||Binge Eating Disorder||# Osfed/Ufed/Ofed||All|
(n = 15)
(n = 20)
(n = 70)
(n = 82)
(n = 22)
(n = 5)
|N = 107|
|Median (IQR)||Z (p) †||Median (IQR)||Z (p)||Median (IQR)||MWU Z (p)|
|EDE eating concern||2.00|
|EDE shape concern||5.00|
|EDE weight concern||4.20|
|Binge Eating Scale||35.00|
|Body Mass Index (kg/m2)||32.60|
|Days out of role/28 days||10.00|
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Amorim Palavras, M.; Hay, P.; Claudino, A. An Investigation of the Clinical Utility of the Proposed ICD-11 and DSM-5 Diagnostic Schemes for Eating Disorders Characterized by Recurrent Binge Eating in People with a High BMI. Nutrients 2018, 10, 1751. https://doi.org/10.3390/nu10111751
Amorim Palavras M, Hay P, Claudino A. An Investigation of the Clinical Utility of the Proposed ICD-11 and DSM-5 Diagnostic Schemes for Eating Disorders Characterized by Recurrent Binge Eating in People with a High BMI. Nutrients. 2018; 10(11):1751. https://doi.org/10.3390/nu10111751Chicago/Turabian Style
Amorim Palavras, Marly, Phillipa Hay, and Angélica Claudino. 2018. "An Investigation of the Clinical Utility of the Proposed ICD-11 and DSM-5 Diagnostic Schemes for Eating Disorders Characterized by Recurrent Binge Eating in People with a High BMI" Nutrients 10, no. 11: 1751. https://doi.org/10.3390/nu10111751