Ulrich Voderholzer

Anorexia nervosa is an illness affecting primarily adolescent girls and young women. Clinical guidelines recommend early intervention, with inpatient treatment for more severe cases. We present an evaluation of a multi-modal cognitive–behavioral inpatient treatment (CBT-E) involving carers in specialized units for adolescents. Routine data of 962 adolescent inpatients (26 boys) (mean age 15.48 [1.26]; range 12–17 years) were analyzed. Predictors of good body weight outcome (achieving a discharge BMI of at least 18.5 kg/m2) were identified by logistic regression analysis. Mean inpatient treatment lasted 96.69 (45.96) days. The BMI increased significantly from 14.93 (1.38) kg/m2 at admission to 17.53 (1.58) kg/m2 at discharge (z = 26.41; p < 0.001; d = 1.708). Drive for thinness decreased from 29.08 (9.87) to 22.63 (9.77; z = 18.41; p < 0.001; d = 0.787). All other subscores of the Eating Disorder Inventory also decreased significantly, with small to medium effect sizes. General psychopathology also showed significant decreases. The Beck Depression Inventory-II score decreased from 26.06 (11.74) to 16.35 (12.51; z = 18.41; p < 0.001; d = 0.883). A good body weight outcome was predicted by a higher BMI at admission (OR = 1.828), age at onset at 15 years or higher (OR = 1.722), and higher Somatization (OR = 1.436), Anxiety (OR = 1.320), and Bulimia (OR = 1.029) scores. CBT-E involving carers is an efficient intervention for adolescents with anorexia nervosa.

Objective The new ICD‐11 eating disorders (ED) guidelines are similar to the DSM‐5 criteria. One difference to the DSM‐5 is the inclusion of subjective binges in the definition of bulimia nervosa (BN) and binge‐eating disorder (BED). The aim of this study was to identify differences between the ICD‐11 guidelines and DSM‐5 ED criteria, which could impact access to medical care and early treatment. Method Data of 3863 ED inpatients who completed the Munich Eating and Feeding Disorder Questionnaire were analyzed using standardized diagnostic algorithms for DSM‐5 and ICD‐11. Results Agreement of diagnoses was high (Krippendorff's α = .88, 95% CI [.86, .89]) for anorexia nervosa (AN; 98.9%), BN (97.2%) and BED (100%), and lower for other feeding and eating disorders (OFED; 75.2%). Of the 721 patients with a DSM‐5 OFED, 19.8% were diagnosed with AN, BN or BED by the ICD‐11 diagnostic algorithm, reducing the number of OFED diagnoses. One‐hundred and twenty‐one patients received an ICD‐11 diagnosis of BN or BED because of subjective binges. Discussion For over 90% of patients, applying either DSM‐5 or ICD‐11 diagnostic criteria/guidelines resulted in the same full‐threshold ED diagnosis. Sub‐threshold and feeding disorders exhibited a discrepancy of 25%. Public Significance Statement For about 98% of inpatients, the ICD‐11 and DSM‐5 agree on the same specified eating disorder diagnosis. This is important when comparing diagnoses made by different diagnostic systems. Including subjective binges in the definition of bulimia nervosa and binge‐eating disorder contributes to improved ED diagnoses. Clarifying the wording of diagnostic criteria at several places could further increase this agreement.