Children into DSM don't go: a comparison of classification systems for eating disorders in childhood and early adolescence.

OBJECTIVE: To evaluate the reliability of diagnostic classification systems for eating disorders when applied to children and young adolescents.

METHOD: Eighty-one patients were randomly selected from a population of 226 children (age 7-16) presenting with eating difficulties to a specialist clinic. Diagnoses were assigned according to three classification systems: the 10th edition of the International Classification of Diseases (ICD 10), the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), and Great Ormond Street (GOS) criteria. Ratings were performed by two clinicians blind to the diagnosis of the other.

RESULTS: Interrater reliability values (kappa) for the three systems were 0.357 (ICD 10), 0.636 (DSM-IV), and 0.879 (GOS). Using DSM criteria, more than 50% of children were classified as eating disorder not otherwise classified (EDNOS) or could not be classified.

DISCUSSION: DSM-IV and ICD 10 criteria are of little value in the classification of the eating difficulties of children. The GOS criteria, which were developed for this age range, are more reliable. The classification of eating disorders in childhood needs reevaluation.