Empirically based subgrouping of eating disorders in adolescents: A longitudinal perspective

BACKGROUND: Successive DSM versions struggle with the heterogeneity of the eating disorders. Criteria were mainly based on clinical impressions and on descriptive and inferential studies. METHOD: In a study of 55 eating-disordered adolescents, we investigated whether patients could be grouped on an empirical basis, using principal components analysis (PCA) with optimal scoring (scaling), i.e. PCA with no a priori assumptions. Clustering was based on Morgan-Russell subscales, each measured four times over the course of illness. RESULTS: Contrary to DSM-IV criteria, patients did not cluster primarily on the basis of anorectic symptoms; the occurrence of bulimic symptoms was more dominant. Core symptomatology (preoccupation with food, disturbed body perception and inadequate sexual behaviour) did not differ between patients, either at referral or over time. CONCLUSIONS: These results support the spectrum hypothesis of the eating disorders, which considers them as one syndrome with different manifestations.