{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T13:31:31Z","timestamp":1760016691272},"reference-count":41,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2009,7,20]],"date-time":"2009-07-20T00:00:00Z","timestamp":1248048000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Intl J Eating Disorders"],"published-print":{"date-parts":[[2009,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective:<\/jats:title><jats:p>To review the evidence for the validity and utility of subtyping bulimia nervosa (BN) into a purging (BN\u2010P) and a nonpurging subtype (BN\u2010NP), and of distinguishing BN\u2010NP from binge eating disorder (BED), by comparing course, complications, and treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method:<\/jats:title><jats:p>A literature search of psychiatry databases for studies published in peer\u2010reviewed journals that used the DSM\u2010definitions of BN and BED, and included both individuals with BN\u2010NP and individuals with BN\u2010P and\/or BED.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results:<\/jats:title><jats:p>Twenty\u2010three studies compared individuals with BN\u2010NP (<jats:italic>N<\/jats:italic> = 671) to individuals with BN\u2010P (<jats:italic>N<\/jats:italic> = 1795) and\/or individuals with BED (<jats:italic>N<\/jats:italic> = 1921), two of which reported on course, 12 on comorbidity and none on treatment response\u2014the indicators for validity and clinical utility. The differences found were mainly quantitative rather than qualitative, suggesting a gradual difference in severity from BN\u2010P (most severe) through BN\u2010NP to BED (least severe).<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion:<\/jats:title><jats:p>None of the comparisons provided convincing evidence for the validity or utility of the BN\u2010NP diagnosis. Three options for the position of BN\u2010NP in DSM\u2010V were suggested: (1) maintaining the BN\u2010NP subtype, (2) dropping nonpurging compensatory behavior as a criterion for BN, so that individuals currently designated as having BN\u2010NP would be designated as having BED, and (3) including BN\u2010NP in a broad BN category. \u00a9 2009 American Psychiatric Association. 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