Patient subgrouping in anorexia nervosa using psychologically‐based classification

DSM-III separates eating disorder patients on the basis of weight and behavioural criteria and specifically distinguishes between bulimia and the bulimic variant of anorexia nervosa, although these groups have been found in some studies to be similar on psychometric and clinical grounds. A clinical distinction is also made between restricter and bulimic anorexia nervosa patients. To test these classifications, cluster analysis was employed to identify empirically-derived patient subgroups among a sample of anorexia nervosa and bulimia patients (n = 78). In addition, the clustering was based on the psychological dimensions of the Eating Disorder Inventory (EDI) rather than weight and behavioural dimensions. The analyses identified two clusters whose membership did not confirm the classification used in DSM-III or the expected dichotomy between restricter and bulimic anorexia nervosa patients. The first cluster contained ten anorexia nervosa restricters, one anorexia nervosa bulimic, and approximately a third of the bulimia patients. The second cluster contained seven restricting and twelve bulimic anorexics, and the remaining two-thirds of the bulimia patients. The second cluster was characterised by low ideal weight, weight overestimation, weight dissatisfaction, and self-esteem deficits that were linked to severe depression as measured by the Beck Depression Inventory (BDI). These findings are discussed.