Less symptomatic, but equally impaired: Clinical impairment in restricting versus binge-eating/purging subtype of anorexia nervosa

Objective: This study investigated subtype differences in eating disorder-specific impairment in a treatment-seeking sample of individuals with anorexia nervosa (AN). Method: The Clinical Impairment Assessment (CIA) and the Eating Disorder Examination-Questionnaire (EDE-Q) were administered to 142 patients. Of these, 54.9% were classified as restricting type (AN-R) and 45.1% were classified as binge-eating/purging type (AN-B/P) based on an average weekly occurrence of binge eating and/or purging episodes (>= 4 episodes/28 days). Results: Individuals with AN-B/P exhibited higher levels of core ED psychopathology (dietary restraint, eating concern, shape/weight concerns) in addition to the expected higher frequency of binge/purge episodes. No significant differences existed between AN subtypes in the severity of ED-related impairment. Weight/shape concerns and binge eating frequency significantly predicted level of impairment. Differential associations were observed between the type of ED pathology that significantly contributed to impairment according to AN subtype. Discussion: Although those with AN-B/P displayed higher levels of core attitudinal and behavioral ED pathology than AN-R, no significant differences in ED-specific impairment were found between AN subtypes. Eating disorder- related impairment in AN was not related to the severity of underweight or purging behaviors, but was uniquely and positively associated with weight/shape concerns and binge eating frequency.