Q & A: Translating the ‘Transdiagnostic Approach’

Q: I’ve heard about research in eating disorders that deals with a “transdiagnostic approach.” Can you explain what this is? (B.C., Chicago)

A: Many concerns exist about the current system of DSM-IV diagnoses for the eating disorders, and these concerns are likely to heat up in the discussions leading to the development of DSM-V. Basically the present system is primarily “categorical,” with distinct diagnostic criteria and cutoff points established for the various criteria used to diagnose anorexia nervosa (both the restricter and binge eating/purging types) and bulimia nervosa, so that you either “have it or you don’t.”

The large wastebasket of “Eating Disorders Not Otherwise Specified,” or EDNOS, comprises probably the largest group of patients with food and weight issues seen in clinical practice. The transdiagnostic approach recognizes that many overlapping dimensions exist in the eating disorders, and suggests that thinking about eating disorders as a whole from a behavioral dimension and/or psychological dimension perspective may yield important insights into these disorders.

Some recent behavioral-genetics studies have adopted this strategy. Research studies using these approaches have looked at “lifetime eating disorder behaviors” such as objective binge eating, self-induced vomiting, laxative misuse, fasting and self-reported low body weight. Psychological dimensions, including depressed mood, poor self-esteem, impulsivity, perfectionism, body dissatisfaction, weight and shape concerns, neuroticism, dependency, and harm avoidance, also have been examined (J Nerv Mental Diseases 2006; 194:510).

We are all eager to see what specific advantages and advances for eating disorders assessment and treatment might emerge from research based on these approaches.

— J.Y.