Introduction
Anorexia nervosa | |
Essential (required) features:
• Significantly low body weight for the individual’s height, age, developmental stage and weight history that is not due to the unavailability of food and is not better accounted for by another medical condition. A commonly used guideline is body mass index (BMI) less than 18.5 kg/m2 in adults and BMI-for-age under 5th percentile in children and adolescents. Rapid weight loss (e.g., more than 20% of total body weight within 6 months) may replace the low body weight guideline as long as other diagnostic requirements are met. Children and adolescents may exhibit failure to gain weight as expected based on the individual developmental trajectory rather than weight loss. • A persistent pattern of restrictive eating or other behaviors that are aimed at establishing or maintaining abnormally low body weight, typically associated with extreme fear of weight gain. Behaviors may be aimed at reducing energy intake, by fasting, choosing low calorie food, excessively slow eating of small amounts of food, and hiding or spitting out food, as well as purging behaviors, such as self-induced vomiting and use of laxatives, diuretics, enemas, or omission of insulin doses in individuals with diabetes. Behaviors may also be aimed at increasing energy expenditure through excessive exercise, motor hyperactivity, deliberate exposure to cold, and use of medication that increases energy expenditure (e.g., stimulants, weight loss medication, herbal products for reducing weight, thyroid hormones). • Low body weight is overvalued and central to the person’s self-evaluation, or the person’s body weight or shape is inaccurately perceived to be normal or even excessive. Preoccupation with weight and shape, when not explicitly stated, may be manifested by behaviors such as repeatedly checking body weight using scales, checking one’s body shape using tape measures or reflection in mirrors, constant monitoring of the calorie content of food and searching for information on how to lose weight or by extreme avoidant behaviors, such as refusal to have mirrors at home, avoidance of tight-fitting clothes, or refusal to know one’s weight or purchase clothing with specified sizing. | |
Bulimia nervosa | |
Essential (required) features:
• Frequent, recurrent episodes of binge eating (e.g., once a week or more over a period of at least 1 month). Binge eating is defined as a distinct period of time during which the individual experiences a loss of control over his or her eating behavior. A binge eating episode is present when an individual eats notably more and/or differently than usual and feels unable to stop eating or limit the type or amount of food eaten. Other characteristics of binge eating episodes may include eating alone because of embarrassment, eating foods that are not part of the individual’s regular diet, eating large amounts of food in spite of not feeling hungry, and eating faster than usual. • Repeated inappropriate compensatory behaviors to prevent weight gain (e.g., once a week or more over a period of at least 1 month). The most common compensatory behavior is self-induced vomiting, which typically occurs within an hour of binge eating. Other inappropriate compensatory behaviors include fasting or using diuretics to induce weight loss, using laxatives or enemas to reduce the absorption of food, omission of insulin doses in individuals with diabetes, and strenuous exercise to greatly increase energy expenditure. • Excessive preoccupation with body weight and shape. When not explicitly stated, preoccupation with weight and shape may be manifested by behaviors such as repeatedly checking body weight using scales, checking one’s body shape using tape measures or reflection in mirrors, constant monitoring of the calorie content of food and searching for information on how to lose weight or by extreme avoidant behaviors, such as refusal to have mirrors at home, avoidance of tight-fitting clothes, or refusal to know one’s weight or purchase clothing with specified sizing. • There is marked distress about the pattern of binge eating and inappropriate compensatory behavior or significant impairment in personal, family, social, educational, occupational or other important areas of functioning. • The symptoms do not meet the definitional requirements for Anorexia Nervosa. | |
Binge eating disorder | |
Essential (required) features:
• Frequent, recurrent episodes of binge eating (e.g., once a week or more over a period of 3 months). Binge eating is defined as a distinct period of time during which the individual experiences a loss of control over his or her eating behavior. A binge eating episode is present when an individual eats notably more or differently than usual and feels unable to stop eating or limit the type or amount of food eaten. Other characteristics of binge eating episodes may include eating alone because of embarrassment, or eating foods that are not part of the individual’s regular diet. • The binge eating episodes are not regularly accompanied by inappropriate compensatory behaviors aimed at preventing weight gain. • The symptoms and behaviors are not better explained by another medical condition (e.g., Prader-Willi Syndrome) or another mental disorder (e.g., a depressive disorder) and are not due to the effect of a substance or medication on the central nervous system, including withdrawal effects. • There is marked distress about the pattern of binge eating or significant impairment in personal, family, social, educational, occupational or other important areas of functioning. | |
Avoidant-restrictive food intake disorder | |
Essential (required) features:
• Avoidance or restriction of food intake that results in either or both of the following: o The intake of an insufficient quantity or variety of food to meet adequate energy or nutritional requirements that has resulted in significant weight loss, clinically significant nutritional deficiencies, dependence on oral nutritional supplements or tube feeding, or has otherwise negatively affected the physical health of the individual. o Significant impairment in personal, family, social, educational, occupational or other important areas of functioning (e.g., due to avoidance or distress related to participating in social experiences involving eating). • The pattern of eating behavior is not motivated by preoccupation with body weight or shape or by significant body image distortion. • Restricted food intake and consequent weight loss (or failure to gain weight) or other impact on physical health is not due to unavailability of food, not a manifestation of another medical condition (e.g., food allergies, hyperthyroidism), and not due to the effect of a substance or medication (e.g., amphetamine), including withdrawal, and not due to another mental disorder. | |
Pica | |
Essential (required) features:
• Regular consumption of non-nutritive substances, such as non-food objects and materials (e.g., clay, soil, chalk, plaster, plastic, metal and paper), or raw food ingredients (e.g., large quantities of salt or corn flour). • The ingestion of non-nutritive substances is persistent or severe enough to require clinical attention. That is, the behavior causes damage to health, impairment in functioning, or significant risk due to the frequency, amount or nature of the substances or objects ingested. • Based on age and level of intellectual functioning, the individual would be expected to distinguish between edible and non-edible substances. In typical development, this occurs at approximately 2 years of age. • The symptoms or behaviors are not a manifestation of another medical condition (e.g., nutritional deficiency). | |
Rumination-regurgitation disorder | |
Essential (required) features:
• The intentional and repeated bringing up of previously swallowed food back to the mouth (i.e., regurgitation), which may be re-chewed and re-swallowed (i.e., rumination), or may be deliberately spat out (but not as in vomiting). • The regurgitation behavior is frequent (at least several times per week) and sustained over a period of at least several weeks. • The diagnosis should only be assigned to individuals who have reached a developmental age of at least 2 years. • The regurgitation behavior is not a manifestation of another medical condition that directly causes regurgitation (e.g., esophageal strictures or neuromuscular disorders affecting esophageal functioning) or causes nausea or vomiting (e.g., pyloric stenosis). |
Methods
Description of study design
Eight core questions
Participants
Development of case vignettes
Vignette number | Key features of case vignette | Accurate diagnosis according to the ICD-10 guidelines | Accurate diagnosis according to the ICD-11 guidelines |
---|---|---|---|
1A | Past history of AN with amenorrhea Weight restored greater than 1 month but less than 1 year Still in treatment for AN No current weight loss behaviors but limited preoccupation with weight/shape that did not impact weight maintenance | No diagnosis/atypical anorexia nervosa | Anorexia nervosa |
1B | Same as 1A, but weight restored for more than 1 year | No diagnosis | No diagnosis |
1C | All key features of AN present for more than 1 month (i.e., limited food intake, and a clear fear of gaining weight or body image distortion) Individual also has amenorrhea Adolescent female | Anorexia nervosa | Anorexia nervosa |
2A | Restricting food (avoidance of certain types of foods due to their sensorial characteristics, not because they were high calorie foods) and is consequently underweight Body image and fear of fatness denied and are not evident in behaviors Psychosocial functioning impaired Adolescent female | Other ED/ED unspecified/atypical AN/feeding disorder of infancy or childhood | ARFID |
2B | Unusual eating habits but not diagnostic No distress Within normal weight range No psychosocial impairment | No diagnosis | No diagnosis |
2C | Food restriction due to subjective somatic discomfort (does not limit specific kinds of foods, per se, just the amount) Underweight Body image and fear of fatness denied and are not evident in behaviors Adolescent female | Atypical anorexia nervosa/other ED/ED unspecified | ARFID |
3A | Binge eating objectively large Compensation (purging) present Normal weight range | Bulimia nervosa | Bulimia nervosa |
3B | Same symptoms and behaviors as 3A except binge eating subjectively large (perceived to be large by the individual) Slightly overweight (BMI 26) | Atypical bulimia nervosa/other ED/ED unspecified | Bulimia nervosa |
3C | Similar to 3A except is obese (BMI 31) | Bulimia nervosa | Bulimia nervosa |
4A | All criteria for binge eating disorder Overweight (BMI 27) Binge eating objectively large Compensation not present | Overeating associated with other psychological disturbances/atypical bulimia nervosa/other ED/ED unspecified | Binge eating disorder |
4B | Overeating with no loss of control or marked distress | No diagnosis | No diagnosis |
4C | Similar to 4A but obese (BMI 34) | Overeating associated with other psychological disturbances/atypical bulimia nervosa/other ED/ ED unspecified | Binge eating disorder |
Procedures
Statistical analysis
Results
Participants
Language group | ||||||
---|---|---|---|---|---|---|
All | English | Spanish | Japanese | French | Chinese | |
N (%)
| 1061 (46%) | 315 (14%) | 340 (15%) | 219 (10%) | 353 (15%) | |
WHO global region | ||||||
Africa | 64 (2.8%) | 50 (4.7%) | 0 | 0 | 14 (6.4%) | 0 |
USA and Canada | 229 (10.0%) | 221 (20.8%) | 1 (0.3%) | 0 | 7 (3.2%) | 0 |
Latin America/Caribbean | 276 (12.1%) | 43 (4.1%) | 226 (71.8%) | 0 | 7 (3.2%) | 0 |
Eastern Mediterranean | 52 (2.3%) | 46 (4.3%) | 0 | 0 | 6 (2.7%) | 0 |
Europe | 755 (33.0%) | 484 (45.6%) | 86 (27.3%) | 0 | 185 (84.5%) | 0 |
Southeast Asia | 144 (6.3%) | 144 (13.6%) | 0 | 0 | 0 | 0 |
Western Pacific—Asia | 695 (30.3%) | 5 (0.5%) | 0 | 337 (99.1%) | 0 | 353 (100%) |
Western Pacific—Oceania | 66 (2.9%) | 66 (6.2%) | 0 | 0 | 0 | 0 |
Missing | 8 (0.3%) | 2 (0.2%) | 2 (0.6%) | 3 (0.9%) | 1 (0.5%) | 0 |
Male:Female | 1277:985 (56:43)% | 557:479 (53:47)% | 153:162 (49:51)% | 255:85 (75:25)% | 122:96 (56:44)% | 190:163 (54:46)% |
Profession | ||||||
Medicine | 1367 (59.7%) | 515 (48.5%) | 125 (39.7%) | 270 (79.4%) | 145 (66.2%) | 312 (88.4%) |
Psychology | 693 (30.3%) | 397 (37.4%) | 161 (51.1%) | 52 (15.3%) | 58 (26.5%) | 25 (7.1%) |
Counseling | 85 (3.7%) | 68 (6.4%) | 3 (1.0%) | 3 (0.9%) | 2 (0.9%) | 9 (2.5%) |
Nursing | 49 (2.1%) | 26 (2.5%) | 2 (0.6%) | 6 (1.8%) | 11(5.0%) | 4 (1.1%) |
Social work | 24 (1.0%) | 17 (1.6%) | 3 (1.0%) | 1 (0.3%) | 0 | 3 (0.8%) |
Sex therapy | 6 (0.3%) | 6 (0.6%) | 0 | 0 | 0 | 0 |
Speech therapy | 2 (0.1%) | 2 (0.2%) | 0 | 0 | 0 | 0 |
Other | 62 (2.7%) | 30 (2.8%) | 21 (6.7%) | 8 (2.4%) | 3 (1.4%) | 0 |
Mean (SD)
| ||||||
Age | 44.52 (11.08) | 46.22 (10.91) | 45.96 (11.75) | 44.64 (10.26) | 42.62 (12.29) | 39.17 (8.87) |
Years of experience | 13.77 (10.12) | 14.60 (10.08) | 16.56 (10.58) | 13.31 (9.89) | 13.73 (10.82) | 9.29 (7.95) |
Eight core questions (Table 4)
Core scientific question | Rationale | Vignette comparison ICD-11 diagnosis | Results |
---|---|---|---|
1. Does the proposed addition of ARFID in the ICD-11 result in individuals with ARFID being more accurately distinguished from AN, and does the proposed addition of ARFID to ICD-11 reduce the number of individuals diagnosed with residual eating disorders (atypical, other specified, and unspecified)? | The proposal to include ARFID in ICD-11 raised the research question as to whether ARFID when it is associated with underweight status can be accurately distinguished from AN using proposed ICD-11 guidelines | Vignette 1C: AN vs Vignette 2A: ARFID | ICD-11 AN DX: 96.6% accuracy ICD-10 AN DX: 93.7% accuracy χ2 (1) = 1.38, p = .24 ICD-11 ARFID DX: 89.9% accuracy ICD-10 ARFID DX*: 80.4% accuracy χ2 (1) = 2.34, p = .13 ICD-11 ARFID DX vs AN DX: χ2 (2) = 246.25, p < 0.001 Overall ICD-11 was equal to ICD-10, but ICD-10 “applicable” options are spread across four diagnoses* G2 (4) = 7.32, p = .16 |
2. Can clinicians distinguish between ARFID and no eating pathology based on the proposed ICD-11 guidelines? | The addition of a “new” diagnosis always raises the question of whether the proposed disorder can be properly distinguished from no disorder. The core research question addressed by this comparison was whether clinicians could better distinguish between ARFID and cases that should not be assigned a diagnosis based on the proposed ICD-11 guidelines as compared to the range of eating disorder residual categories in ICD-10. | Vignette 2A: ARFID vs Vignette 2B: No DX | ICD-11 ARFID DX: 88.5% accuracy ICD-10 ARFID DX*: 76.8% accuracy χ2 (1) = 6.71, p < .01 ICD-11 No DX: 78.4% accuracy ICD-10 No DX: 79.6% accuracy χ2 (1) = 0.17, p = .68. ICD-11 ARFID DX vs No DX χ2 (2) = 190.00, p < 0.001 Overall ICD-11 Outperformed ICD-10 G2 (4) = 17.80, p < 0.01. |
3. Some individuals present with atypical reasons for restricting eating, such as feeling uncomfortable when full. In such cases, can clinicians accurately distinguish between AN and ARFID based on the proposed ICD-11 guidelines? | The diagnostic guidelines for a new disorder must sufficiently differentiate it from other existing disorders. We tested whether the proposed inclusion of ARFID can be clearly distinguished from AN when the rationale for restricting intake is atypical (e.g., restricting eating because of stomach fullness or bloating. | Vignette 1C: AN vs Vignette 2C: ARFID | ICD-11 AN DX: 96.7% accuracy ICD-10 AN DX: 97.0% accuracy χ2 (1) = 0.02, p = .89 ICD-11 ARFID DX: 87.9% accuracy ICD-10 ARFID DX**: 76.0% accuracy χ2 (1) = 6.90, p < 0.01 ICD-11 AN DX vs ARFID DX: χ2 (2) = 262.84, p < 0.001 Overall ICD-11 outperformed ICD-10 G2 (4) = 14.62, p < 0.01 |
4. ICD-11 proposes that a diagnosis of AN be retained until an individual has at least one year of stabilized sufficient weight gain and cessation of behaviors aimed at promoting weight loss. Does this rule improve diagnostic accuracy for AN over the course of recovery? | ICD-10 does not provide clear diagnostic guidance for recently weight restored individuals with AN, which results in substantial variability in whether an AN diagnosis is applied to cases that still exhibit significant symptoms but have gained weight to within a relevant weight reference (e.g., based on BMI or population quartile). ICD-11 proposes that the diagnosis of AN continue to be applied until the individual has achieved attitudinal and weight recovery for 1 year without the support of continuing care. | Vignette 1A: AN (with recovery not yet independently sustained for 1 year) vs Vignette 1B: no DX (AN with recovery independently sustained over 1 year) | ICD-11 AN DX: 84.6% accuracy for 1A ICD-11 no DX: 38.4% accuracy for 1BϮ ICD-11 AN DX vs no DX χ2 (2) = 46.82, p < .001 (No independent ICD-10 comparison because this rule is new to ICD-11) Overall ICD-11 outperformed ICD-10 G2 (4)ϮϮ = 31.84, p < 0.0001 |
5. Is the proposal to include subjective binge eating in ICD-11 BN clinically useful and effective in reducing residual eating disorder diagnoses? | The ICD-11 recommendation to allow subjective binge eating to fulfill a part of the diagnostic requirements for both BN and BED was based on extant data suggesting that the threshold for an objective binge episode is arbitrary and clinical reports indicating that binge size does not predict distress or impairment. Although intended to improve clinical utility, the ICD-11 inclusion of subjective binge eating could inadvertently make the diagnosis of BN or BED more difficult. | Vignette 3A: BN (with objective binge eating) vs Vignette 3B: BN (with subjective binge eating) | ICD-11 Objective BN DX: 84.3% accuracy ICD-10 Objective BN DX: 82.2% accuracy χ2 (1) = 0.23, p = .63 ICD-11 Subjective BN DX: 61.4% accuracy ICD-10 Subjective BN DX***: 69.6% accuracy χ2 (1) = 10.62, p < 0.001 ICD-11 objective BN DX vs subjective BN DX: χ2 (1) = 20.25, p < 0.001 Clinicians were more accurate in diagnosing BN with objective binge eating Overall ICD-11 outperformed ICD-10 G2 (2) = 10.90, p < 0.01. |
6. Do the proposed guidelines for ICD-11 enable clinicians to accurately distinguish between BN and BED? | This question is prompted by the inclusion of the new category of BED in ICD-11. | Vignette 3A: BN vs Vignette 4A: BED | ICD-11 BN DX: 90.2% accuracy ICD-10 BN DX: 83.3% accuracy χ2 (2) = 8.73, p < 0.05 ICD-11 BED DX: 78.0% accuracy ICD-10 BED “equivalent” DX: 70.7% accuracy χ2 (2) = 2.05, p = .36 ICD-11 BN DX vs BED DX χ2 (2) = 182.50, p < 0.001 ICD-10 BN DX vs BED DX**** Wide variability of DX since BED does not exist in ICD-10. χ2 (2) = 152.99, p < 0.001 Overall ICD-11 outperformed ICD-10 G2 (4) = 11.40, p < 0.05 |
7. Are the proposed ICD-11 guidelines for BED clinically useful in distinguishing BED from no disorder? | Similar to Question 2, given the addition of BED to the ICD-11, the question arises whether the proposed disorder of BED can be properly distinguished from no disorder. | Vignette 4A: BED vs Vignette 4B: No DX | ICD-11 BED DX: 82.4% accuracy ICD-10 BED (equivalent) DX****: 72.5% accuracy χ2 (2) = 6.71, p < 0.05 ICD-11 No DX: 80.3% accuracy ICD-10 No Dx: 76.8% accuracy χ2 (2) = 10.54, p < 0.01 ICD-11 BED vs No DX: χ2 (2) = 203.40, p < 0.001 Overall ICD-11 outperformed ICD-10 G2 (4) = 18.24, p < 0.01 |
8. Do the proposed ICD-11 guidelines provide sufficient clinical guidelines to distinguish BN and BED regardless of weight status? | This comparison examined the impact of weight status on the diagnosis of BN and BED. According to both the proposed ICD-11 guidelines and the ICD-10 guidelines, weight status should not impact diagnosis of BN and BED. However, given that the majority of individuals who present with BED for clinical care are also overweight, this question is designed to assess whether clinicians are able to accurately distinguish between BN and BED regardless of weight status. | Vignette 3A: BN normal weight vs Vignettes 3C: BN with obesity Vignette 4A: BED slightly overweight vs Vignette 4C: BED with obesity Vignettes 3C: BN with obesity vs Vignette 4C: BED with obesity | ICD-11 BN DX with obesity: 88.5% accurate ICD-11 BN DX normal weight: 90.2% accurate χ2 (2) = 3.25, p = .20 ICD-11 BED DX obese: 90.5% accurate ICD-11 BED DX slightly overweight: 82.4% accurate χ2 (2) = 8.90, p < 0.05 ICD-11 BED DX obese vs BN DX obese χ2 (2) = 213.70, p < 0.001 ICD-10 BED “equivalent” DX**** with obesity: 83.2% accurate ICD-10 BED “equivalent” DX**** with slight overweight status: 70.7% accurate χ2 (2) = 7.64, p < 0.05 ICD-10 BN DX with obesity: 69.3% accurate ICD-10 BN DX normal weight: 83.32% accurate χ2 (2) = 8.18, p < 0.05 ICD-11 vs ICD-10 for BN DX with obesity χ2 (2) = 17.43, p < 0.001 ICD-11 vs ICD-10 for BED DC with obesity /BED “equivalent” DX with obesity χ2 (2) = 3.52, p = .17 Overall ICD-11 outperformed ICD-10 for obese individuals with either BN or BED G2 (4) = 21.54, p < 0.001 |
Clinical utility of the diagnoses
Diagnostic category | Not at all | Somewhat | Quite | Extremely | *Quite + Extremely | |
---|---|---|---|---|---|---|
Ease of use N (%) | ||||||
ICD-11 AN | 2 (0.5%) | 62 (14.7%) | 223 (52.8%) | 135 (32.0%) | 358 (84.8%) | χ2 (3) = 10.17, p < 0.05 |
ICD-10 AN | 12 (3.5%) | 56 (16.2%) | 170 (49.1%) | 108 (31.2%) | 278 (80.3%) | |
ICD-11 BN | 6 (1.5%) | 50 (12.3%) | 188 (46.4%) | 161 (39.8%) | 349 (86.2%) | χ2 (3) = 47.25, p < 0.001 |
ICD-10 BN | 12 (3.5%) | 82 (24.2%) | 182 (53.7%) | 63 (18.6%) | 245 (72.3%) | |
ICD-11 BED | 2 (0.6%) | 32 (9.6%) | 184 (55.1%) | 116 (34.7%) | 300 (89.8%) | χ2 (3) = 68.24, p < 0.001 |
ICD-10 Overeating | 13 (7.6%) | 47 (27.5%) | 94 (55.0%) | 17 (9.9%) | 111 (64.9%) | |
ICD-11 ARFID | 8 (2.0%) | 51 (13.0%) | 219 (55.7%) | 115 (29.3%) | 334 (85.0%) | χ2 (3) = 21.63, p < 0.001 |
ICD-10 Atypical AN | 5 (4.3%) | 53 (28.6%) | 83 (44.9%) | 44 (23.8%) | 127 (68.7%) | |
Goodness of fit N (%) | ||||||
ICD-11 AN | 0 (0%) | 53 (12.6%) | 238 (56.4%) | 131 (31.0%) | 369 (87.4%) | χ2 (3) = 14.07, p < 0.01 |
ICD-10 AN | 6 (1.7%) | 66 (19.1%) | 177 (51.2%) | 97 (28.0%) | 274 (79.2%) | |
ICD-11 BN | 6 (1.5%) | 44 (10.9%) | 197 (48.6%) | 158 (39.0%) | 355 (87.6%) | χ2 (3) = 69.35, p < 0.001 |
ICD-10 BN | 1 (0.3%) | 95 (28.0%) | 190 (56.0%) | 53 (15.6%) | 243 (71.6%) | |
ICD-11 BED | 2 (0.6%) | 97 (29.0%) | 175 (52.4%) | 118 (35.3%) | 293 (87.7%) | χ2 (3) = 33.28, p < 0.001 |
ICD-10 Overeating | 9 (5.3%) | 52 (30.4%) | 90 (52.6%) | 20 (11.7%) | 110 (64.3%) | |
ICD-11 ARFID | 3 (0.8%) | 44 (11.2%) | 241 (61.3%) | 105 (26.7%) | 346 (88.0%) | χ2 (3) = 22.13, p < 0.001 |
ICD-10 Atypical AN | 2 (1.1%) | 49 (26.5%) | 94 (50.8%) | 40 (21.6%) | 134 (72.4%) | |
Clarity and understandability N (%) | ||||||
ICD-11 AN | 2 (0.4%) | 46 (10.3%) | 229 (51.2%) | 170 (38.0%) | 399 (89.2%) | χ2 (3) = 27.71, p < 0.001 |
ICD-10 AN | 11 (2.8%) | 80 (20.2%) | 194 (49.0%) | 111 (28.0%) | 305 (77.0%) | |
ICD-11 BN | 4 (1.0%) | 49 (11.7%) | 215 (51.4%) | 150 (35.9%) | 365 (87.3%) | χ2 (3) = 47.05, p < 0.001 |
ICD-10 BN | 11 (2.9%) | 92 (24.5%) | 206 (54.9%) | 66 (17.6%) | 272 (72.5%) | |
ICD-11 BED | 1 (0.3%) | 47 (11.7%) | 213 (53.8%) | 135 (34.1%) | 348 (87.9%) | χ2 (3) = 28.72, p < 0.001 |
ICD-10 Overeating | 8 (4.2%) | 53 (28.0%) | 90 (47.6%) | 38 (20.1%) | 128 (67.7%) | |
ICD-11 ARFID | 8 (1.8%) | 42 (9.6%) | 232 (52.8%) | 157 (35.8%) | 389 (88.6%) | χ2 (3) = 22.18, p < 0.001 |
ICD-10 Atypical AN | 3 (1.4%) | 53 (25.6%) | 95 (45.9%) | 56 (27.1%) | 151 (73.0%) |