Journal Mobile Options
Table of Contents
Vol. 44, No. 1, 2011
Issue release date: January 2011
Psychopathology 2011;44:12–20

Outcomes of Empirical Eating Disorder Phenotypes in a Clinical Female Sample: Results from a Latent Class Analysis

Dechartres A. · Huas C. · Godart N. · Pousset M. · Pham A. · Divac S.M. · Rouillon F. · Falissard B.
aMaison des adolescents, PSIGIAM, U669, INSERM, bUMR S0669, Paris Sud and Paris Descartes University, cInstitut Mutualiste Montsouris, and dClinique des maladies mentales et de l’encéphale, Sainte Anne Hospital, Paris, and eDepartment of Public Health, Paul Brousse Hospital, APHP, Villejuif, France

Individual Users: Register with Karger Login Information

Please create your User ID & Password

Contact Information

I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in


Background/Aims: To empirically classify phenotypes of eating disorders (ED) using latent class analysis (LCA), and to validate this classification based on clinical outcomes. Methods: LCA was applied to 968 inpatients. The resultant classes were validated by clinical outcomes including mortality. Results: A 5-class solution showed the best fit. The symptoms of latent class 1 (LC1; 26% of the sample) resembled anorexia nervosa (AN), bingeing-purging (AN-B/P) subtype; those of LC2 (23%) resembled bulimia nervosa; those of LC3 (11%) were close to AN-B/P without weight and body concerns; those of LC4 resembled restrictive anorexia nervosa (RAN) without weight and body concerns, and those of LC5 RAN. A history of hospitalization for ED was significantly more frequent for LC3 and LC4. The lowest BMI at admission were presented in LC4. LC1 showed the highest level of psychological disturbances and LC4 the lowest. LC3 and LC4 differed from LC1 and LC5 by higher percentages of treatment dropout (64.9 vs. 57.2 and 55.7 vs. 47.5%, respectively; overall p = 0.001). Survival rates tended to be different between the LC (p = 0.09). Conclusions: Subgroups of AN patients with low weight and body concerns seem more severe at hospitalization and more difficult to manage, with a higher rate of treatment dropout than the ‘typical’ AN patients.

Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.


  1. Hudson JI, Hiripi E, Pope HG Jr, Kessler RC: The prevalence and correlates of eating disorders in the national comorbidity survey replication. Biol Psychiatry 2007;61:348–358.
  2. Keski-Rahkonen A, Hoek HW, Susser ES, Linna MS, Sihvola E, Raevuori A, Bulik CM, Kaprio J, Rissanen A: Epidemiology and course of anorexia nervosa in the community. Am J Psychiatry 2007;164:1259–1265.
  3. Godart NT, Perdereau F, Rein Z, Berthoz S, Wallier J, Jeammet P, Flament MF: Comorbidity studies of eating disorders and mood disorders: critical review of the literature. J Affect Disord 2007;97:37–49.
  4. Fedorowicz VJ, Falissard B, Foulon C, Dardennes R, Divac SM, Guelfi JD, Rouillon F: Factors associated with suicidal behaviors in a large French sample of inpatients with eating disorders. Int J Eat Disord 2007;40:589–595.
  5. Steinhausen HC: The outcome of anorexia nervosa in the 20th century. Am J Psychiatry 2002;159:1284–1293.
  6. Duncan AE, Neuman RJ, Kramer J, Kuperman S, Hesselbrock V, Reich T, Bucholz KK: Are there subgroups of bulimia nervosa based on comorbid psychiatric disorders? Int J Eat Disord 2005;37:19–25.
  7. Pinheiro AP, Bulik CM, Sullivan PF, Machado PP: An empirical study of the typology of bulimic symptoms in young Portuguese women. Int J Eat Disord 2008;41:251–258.
  8. Richardson J, Steiger H, Schmitz N, Joober R, Bruce KR, Israel M, Gauvin L, Anestin AS, Dandurand C, Howard H, de Guzman R: Relevance of the 5-HTTLPR polymorphism and childhood abuse to increased psychiatric comorbidity in women with bulimia-spectrum disorders. J Clin Psychiatry 2008;69:981–990.
  9. Striegel-Moore RH, Franko DL, Thompson D, Barton B, Schreiber GB, Daniels SR: An empirical study of the typology of bulimia nervosa and its spectrum variants. Psychol Med 2005;35:1563–1572.
  10. Sullivan PF, Bulik CM, Kendler KS: The epidemiology and classification of bulimia nervosa. Psychol Med 1998;28:599–610.
  11. Mitchell JE, Crosby RD, Wonderlich SA, Hill L, le Grange D, Powers P, Eddy K: Latent profile analysis of a cohort of patients with eating disorders not otherwise specified. Int J Eat Disord 2007;40(suppl):S95–S98.
  12. Bulik CM, Sullivan PF, Kendler KS: An empirical study of the classification of eating disorders. Am J Psychiatry 2000;157:886–895.
  13. Duncan AE, Bucholz KK, Neuman RJ, Agrawal A, Madden PA, Heath AC: Clustering of eating disorder symptoms in a general population female twin sample: a latent class analysis. Psychol Med 2007;37:1097–1107.
  14. Wade TD, Crosby RD, Martin NG: Use of latent profile analysis to identify eating disorder phenotypes in an adult Australian twin cohort. Arch Gen Psychiatry 2006;63:1377–1384.
  15. Keel PK, Fichter M, Quadflieg N, Bulik CM, Baxter MG, Thornton L, Halmi KA, Kaplan AS, Strober M, Woodside DB, Crow SJ, Mitchell JE, Rotondo A, Mauri M, Cassano G, Treasure J, Goldman D, Berrettini WH, Kaye WH: Application of a latent class analysis to empirically define eating disorder phenotypes. Arch Gen Psychiatry 2004;61:192–200.
  16. Wonderlich SA, Crosby RD, Mitchell JE, Engel SG: Testing the validity of eating disorder diagnoses. Int J Eat Disord 2007;40 (suppl):S40–S45.
  17. Walsh BT: DSM-V from the perspective of the DSM-IV experience. Int J Eat Disord 2007;40(suppl):S3–S7.
  18. First MB, Pincus HA, Levine JB, Williams JB, Ustun B, Peele R: Clinical utility as a criterion for revising psychiatric diagnoses. Am J Psychiatry 2004;161:946–954.
  19. Derogatis L: SCL-90. Administration, Scoring, and Procedures Manual for the Revised Version. Baltimore, Clinical Psychometric Research, 1977.
  20. Pariente P, Lepine J, Boulenger P, Zarifian E, Lemperiere T, Lellouch J: The Symptom Checklist-90-R (SCL-90-R) in a French general psychiatric 708 outpatient sample: is there a factor structure? Psychiatr Psychobiol 1989;4:151–157.
  21. Garner DM, Garfinkel PE: The Eating Attitudes Test: an index of the symptoms of anorexia nervosa. Psychol Med 1979;9:273–279.
  22. Carrot G, Lang F, Estour B, Pellet J, Gauthey C, Wagon C: Etude de l’EAT – échelle d’auto-évaluation de l’anorexie mentale – dans une population témoin et dans une population d’anorexiques. Ann Medico Psychol 1987;145:258–263.
  23. Garner D, Olmsted M, Polivy J: Development and validation of a multidimensional Eating Disorder Inventory for anorexia nervosa and bulimia. Int J Eat Disord 1983;2:15–34.

    External Resources

  24. Criquillion-Doublet S, Divac S, Dardennes R, Guelfi J: Le ‘Eating Disorder Inventory’ (EDI); in Guelfi JD, Gaillac V, Dardennes R (eds): Psychopathologie quantitative. Paris, Masson, 1995, pp 249–260.
  25. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J: An inventory for measuring depression. Arch Gen Psychiatry 1961;4:561–571.
  26. Collet L, Cottraux J: Inventaire de la dépression de Beck (13 items): étude de la validité concurrente avec les échelles de Hamilton et de ralentissement de Widlöcher. Encephale 1986;12:77–79.
  27. Hamilton M: A rating scale for depression. J Neurol Neurosurg Psychiatry 1960;23:56–62.
  28. Magidson J, Vermunt J: Latent class models for clustering: a comparison with k-means. Can J Mark 2002;20:37–44.
  29. von Eye A, Gutierrez-Peña E: Configural frequency analysis of large sparse cross-classifications. Psychol Sci 2005;47:356–376.
  30. Schwarz G: Estimating the dimension of a mode. Ann Stat 1978;6:461–464.

    External Resources

  31. van Buuren S, Oudshoorn CGM: Multivariate Imputation by Chained Equations: Mice v1.0 User’s manual. Report PG/VGZ/00038. Leiden, TNO Prevention and Health, 2000.
  32. Mplus version 4.21. Muthén & Muthén, 1998–2007.
  33. Statistical Analysis Software 9.1. Cary, SAS Institute, 2004.
  34. Eddy KT, Dorer DJ, Franko DL, Tahilani K, Thompson-Brenner H, Herzog DB: Diagnostic crossover in anorexia nervosa and bulimia nervosa: implications for DSM-V. Am J Psychiatry 2008;165:245–250.
  35. Wolk SL, Loeb KL, Walsh BT: Assessment of patients with anorexia nervosa: interview versus self-report. Int J Eat Disord 2005;37:92–99.
  36. Strober M, Freeman R, Morrell W: Atypical anorexia nervosa: separation from typical cases in course and outcome in a long-term prospective study. Int J Eat Disord 1999;25:135–142.
  37. Lee S, Chan YY, Hsu LK: The intermediate-term outcome of Chinese patients with anorexia nervosa in Hong Kong. Am J Psychiatry 2003;160:967–972.
  38. Greenfeld D, Anyan W, Hobart M, Quinlan D, Plantes M: Insight into illness and outcome in anorexia nervosa. Int J Eat Disord 1991;10:101–109.

    External Resources

  39. Wade TD: Epidemiology of eating disorders: creating opportunities to move the current classification paradigm forward. Int J Eat Disord 2007;40(suppl):S27–S30.
  40. Vitousek K, Watson S, Wilson GT: Enhancing motivation for change in treatment-resistant eating disorders. Clin Psychol Rev 1998;18:391–420.
  41. Crow SJ, Peterson CB, Swanson SA, Raymond NC, Specker S, Eckert ED, Mitchell JE: Increased mortality in bulimia nervosa and other eating disorders. Am J Psychiatry 2009;166:1342–1346.
  42. Fichter MM, Quadflieg N, Hedlund S: Twelve-year course and outcome predictors of anorexia nervosa. Int J Eat Disord 2006;39:87–100.
  43. Herzog W, Deter HC, Fiehn W, Petzold E: Medical findings and predictors of long-term physical outcome in anorexia nervosa: a prospective, 12-year follow-up study. Psychol Med 1997;27:269–279.
  44. Zipfel S, Lowe B, Reas DL, Deter HC, Herzog W: Long-term prognosis in anorexia nervosa: lessons from a 21-year follow-up study. Lancet 2000;355:721–722.
  45. Herzog DB, Greenwood DN, Dorer DJ, Flores AT, Ekeblad ER, Richards A, Blais MA, Keller MB: Mortality in eating disorders: a descriptive study. Int J Eat Disord 2000;28:20–26.
  46. Woodside DB, Carter JC, Blackmore E: Predictors of premature termination of inpatient treatment for anorexia nervosa. Am J Psychiatry 2004;161:2277–2281.
  47. Vrabel KR, Rosenvinge JH, Hoffart A, Martinsen EW, Ro O: The course of illness following inpatient treatment of adults with longstanding eating disorders: a 5-year follow-up. Int J Eat Disord 2008;41:224–232.
  48. Vandereycken W: The place of inpatient care in the treatment of anorexia nervosa: questions to be answered. Int J Eat Disord 2003;34:409–422.
  49. Fichter MM, Quadflieg N: Long-term stability of eating disorder diagnoses. Int J Eat Disord 2007;40(suppl):S61–S66.
  50. Tozzi F, Thornton LM, Klump KL, Fichter MM, Halmi KA, Kaplan AS, Strober M, Woodside DB, Crow S, Mitchell J, Rotondo A, Mauri M, Cassano G, Keel P, Plotnicov KH, Pollice C, Lilenfeld LR, Berrettini WH, Bulik CM, Kaye WH: Symptom fluctuation in eating disorders: correlates of diagnostic crossover. Am J Psychiatry 2005;162:732–740.
  51. Williamson DA, Gleaves DH, Stewart TM: Categorical versus dimensional models of eating disorders: an examination of the evidence. Int J Eat Disord 2005;37:1–10.

Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50