GCP.Network Study Results

Brief Report on GCP.Network Study on Feeding and Eating Disorders

PARTICIPANTS

A total of 2 288 members of the GCPN completed this study in one of five languages: English (n=1061; 46.4%), Spanish (n=315; 13.8%), Japanese (n=340; 14.9%), French (n=219; 9.6%), and Chinese (n=353; 15.4%). 

PARTICIPANT CHARACTERISTICS

Mean age: 44.5 yrs (SD~10.8 yrs)
Mean professional experience: 13.8 yrs (SD~9.9 yrs)
Male: female ratio: 65.3%: 34.7%

MAJOR RESULTS AND IMPLICATIONS FOR PRACTICE

1.

The revised ICD-11 guidelines led to improvements in the accuracy of Feeding and Eating Disorders diagnoses.

Across diagnoses, diagnostic agreement using ICD-11 was consistently higher than for ICD-10. These findings indicate that the proposed changes to the structure and guidelines for individual conditions in ICD-11 Feeding and Eating Disorders offered greater diagnostic consistency and clarity than the ICD-10 diagnostic guidelines.

2.

The Inclusion of Avoidant/Restrictive Food Intake Disorder (ARFID) and Binge Eating Disorder (BED) in ICD-11 is supported by the field study results.

AVOIDANT/RESTRICTIVE FOOD INTAKE DISORDER:

The addition of Avoidant/Restrictive Food Intake Disorder in ICD-11 expands and renames an ICD-10 category (Feeding Disorder of Infancy and Childhood) to more completely describe a condition characterized by eating an insufficient quantity or variety of food. Data from the case-controlled field trial found that Avoidant/Restrictive Food Intake Disorder provides significant clarification of diagnostic choices in comparison to options available under ICD-10. Further, despite concerns that it would be difficult for clinicians to separate cases of Avoidant/Restrictive Food Intake Disorder and Anorexia Nervosa, this differentiation was made successfully using the ICD-11 guidelines. GCPN members were also able to clearly separate cases of Avoidant/Restrictive Food Intake Disorder and normal picky eating.

BINGE EATING DISORDER:

A significant proposed change to the section on Feeding and Eating Disorders in ICD-11 is the inclusion of Binge Eating Disorder as a new diagnostic category. Appropriate distinctions were made by participants using ICD-11 between Bulimia Nervosa and Binge Eating Disorder, including a case described as overweight. Further, clinicians could successfully determine when a vignette described normal overeating (no sense of loss of control over the eating and minimal guilt/distress about having eaten the food) in comparison to Binge Eating Disorder.

3.

Diagnosis during recovery from anorexia nervosa and the diagnostic importance of "subjective" binge eating required further clarification.

The guidelines tested in the field study indicated that individuals with Anorexia Nervosa should show sustained weight gain/maintenance for at least 1 year in the absence of treatment before the diagnosis should be removed. This guideline aimed to clarify that patients who, as a result of treatment, no longer met the underweight requirement for Anorexia Nervosa should not be given another diagnosis (e.g., Bulimia Nervosa) for what is actually a transient symptom state of the same disorder. However, clinicians participating in the field study exhibited confusion about this aspect of the guidelines, which as a result has been further clarified in the current version of the ICD-11 guidelines.

The proposed definition of binge eating for the diagnoses of Bulimia Nervosa and Binge Eating Disorder in ICD-11 involves an episode during which the individual experiences loss of control over eating, eats notably more or differently than usual, and feels unable to stop eating or limit the type or amount of food eaten. Thus, it is not necessary to consume an objectively large amount of food during a binge eating episode; a subjectively large amount or abnormal type of food in the context of loss of control would be sufficient to satisfy this guideline. Study results suggest some confusion about ‘”subjective” binge eating; clinicians applied this guideline more accurately to individuals described as overweight than to normal weight individuals. This aspect of the guidelines has also been further clarified in the current version of the proposed guidelines

FURTHER READING:

Al-Adawi, S., Bax, B., Bryant-Waugh, R., Claudino, A. M., Hay, P., Monteleone, P., Norring, C., Pike, K. M., Pilon, D. J., Herscovici, C. R., Reed, G. M., Rydelius, P.-A., Sharan, P., Thiels, C., Treasure, J., & Uher, R. (2013). Revision of ICD: Status update on feeding and eating disorders. Advances in Eating Disorders, 1, 10-20. doi: 10.1080/21662630.2013.742971