Compensatory eating disorder and full threshold DSM eating disorders: A comparison of eating-disorder-related psychiatric impairment and symptomatology

Introduction: Compensatory eating disorder (CED) is a newly proposed ‘other specified feeding and eating disorder’ characterized by recurrent non-purging compensatory behaviors (e.g., compulsive exercise and/or food restriction), overvaluation of weight/shape, the absence of objective binge-eating episodes, and the absence of low weight or recent significant weight loss. This study compared individuals with CED to individuals with anorexia nervosa (AN), bulimia nervosa (BN), or binge-eating disorder (BED) on measures of psychiatric impairment, eating-disorder (ED) symptomatology, and comorbid internalizing disorders. Method: Adults (N = 187) with CED, AN, BN, or BED completed measures of ED-related-psychiatric impairment and ED symptomatology. Structured clinical interviews were administered to assess ED and internalizing-disorder diagnoses. Results: Linear regression models were fit to compare the CED group to full-threshold ED groups on psychiatric impairment, body dissatisfaction, cognitive restraint, negative attitudes towards obesity, and weight suppression. A chi-square difference test examined group differences on internalizing-disorder prevalence. Results indicated that the CED group had high levels of psychiatric impairment, yet psychiatric impairment was significantly lower in the CED group compared to other groups. The AN group had significantly lower body dissatisfaction than the CED group. Individuals with CED had similar cognitive restraint, negative attitudes towards obesity, internalizing psychopathology, and weight suppression compared to other ED groups. Conclusion: Individuals with CED had substantial ED psychopathology and internalizing-disorder prevalence, comparable to individuals with full-threshold EDs. Individuals with CED had high levels of psychiatric impairment, but their impairment was lower than individuals with full-threshold EDs. Our results indicate that CED is a clinically significant disorder.