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Incorporating Dimensions into the Classification of Eating Disorders: Three Models and Their Implications for Research and Clinical Practice
Wildes JE and Marcus MD

Integration of dimensional approaches is a growing trend within the mental health field, expanding upon the traditional approach of classifying patients strictly by categories. The DSM-5 Task Force and the National Institute of Mental Health have recommended further investigation of dimensional approaches. Moreover, scientific progress in the fields of neuroscience and statistical methodology has opened up new opportunities for expanded research on this topic. A recently-published review article by Jennifer E. Wildes, PhD and Marsha D. Marcus, PhD of the University of Pittsburgh Department of Psychiatry examined the utility of dimensional approaches specifically relating to the diagnosis of eating disorders.

In this article, Drs. Wildes and Marcus presented three models for integrating dimensional approaches into diagnosis and classification of eating disorders. The first model, dimensions of eating disorder psychopathology, is particularly relevant because assessment of eating disorders can vary greatly due to fluctuating symptoms and indirect, unsystematic relationships among different symptoms. The second model, dimensions of comorbid psychopathology, is key because individuals suffering from eating disorders frequently have other psychiatric issues and diagnoses which coincide with the eating disorder. Additionally, research has indicated that some comorbid psychopathologies may precede, indicate, or even trigger the emergence of an eating disorder. The third model relates neurobiological dimensions with the classification of eating disorders. For instance, supplemental study of the neurocognitive dimensions of impulsivity and compulsivity could point to new approaches for diagnosis and neurobiological treatments of eating disorders.

Drs. Wildes and Marcus concluded that the field is ripe for future research investigating the effectiveness of dimensional approaches as well as the best interplay of categorical classification and dimensional areas as described by the proposed models. At present, dimensional approaches can be implemented in clinical settings to determine severity of an eating disorder and inform treatment decisions, to formulate hypotheses about factors contributing to the eating disorder, and to help determine possible psychological or pharmacological interventions.

Jennifer E. Wildes, PhD and Marsha D. Marcus, PhD (Department of Psychiatry, University of Pittsburgh)

The results of this investigation were published in the July 2013 issue of the International Journal of Eating Disorders. Click here to access the abstract for Dr. Wildes' review article.