Differences in DSM-III-R and DSM-IV diagnoses in eating disorder patients

Two hundred eighty-eight eating disorder patients were administered the DSM -III-R Structured Clinical Interview (SCID) and the DSM-IV SCID for axis I and II. Concordance between DSM-III-R and DSM-IV was excellent for the axis I affective and anxiety disorders, bulimia nervosa, and substance abuse/de pendence. It was also excellent for axis II paranoid, schizoid, borderline, and antisocial personality disorders. Agreement between the two nosologica l systems was lower for alcohol abuse/dependence with a kappa of .63. Kappa s were also poor for the following personality disorders: schizotypal (.44) , histrionic (.29), dependent (.54), obsessive-compulsive (.62) and not oth erwise specified (.63). There was a substantial difference in the diagnosis of anorexia nervosa between DSM-III-R and DSM-IV. Fourteen patients were d iagnosed with anorexia nervosa, binge/purge type, using DSM-IV criteria, wh ile only six received the diagnoses of anorexia nervosa and bulimia nervosa using DSM-III-R criteria. Kappa was .49 and the percent agreement was 79%. While there are considerable areas of overlap in DSM-IV and DSM-III-R, the re are also areas of substantial differences. Clinicians and researchers mu st be very cautious when attempting to compare data from the different noso logies. Copyright (C) 2001 by WB. Saunders Company.