Background Although data suggest that the sense of “loss of control” (LOC) is the most salient aspect of binge eating, the definition of LOC varies widely across eating disorder assessments. The WHO ICD-11 diagnostic guidelines for binge eating do not require an objectively large amount of food, which makes accurate LOC diagnosis even more critical. However, it can be especially challenging to assess LOC in the context of elevated weight status and in the absence of compensatory behaviors. This ICD-11 field sub-study examined how descriptions of subjective experience during distressing eating episodes, in combination with different eating episode sizes, influence diagnoses of binge-eating disorder (BED). Method Mental health professionals with eating disorder expertise from WHO’s Global Clinical Practice Network ( N = 192) participated in English, Japanese, and Spanish. Participants were asked to select the correct diagnosis for two randomly assigned case vignettes and to rate the clinical importance and ease of use of each BED diagnostic guideline. Results The presence of LOC interacted with episode size to predict whether a correct diagnostic conclusion was reached. If the amount consumed during a typical distressing eating episode was only subjectively large compared to objectively large, clinicians were 23.1 times more likely to miss BED than to correctly diagnose it, and they were 9.7 times more likely to incorrectly diagnose something else than to correctly diagnose BED. In addition, clinicians were 10.8 times more likely to make a false positive diagnosis of BED when no LOC was described if the episode was objectively large. Descriptions of LOC that were reliably associated with correct diagnoses across episodes sizes included two that are similar to those already included in proposed ICD-11 guidelines and a third that is not. This third description of LOC focuses on giving up attempts to control eating because perceived overeating feels inevitable. Conclusions Results highlight the importance of detailed clarification of the LOC construct in future guidelines. Explicitly distinguishing LOC from distressing and mindless overeating could help promote consistent and accurate diagnosis of BED versus another or no eating disorder.

中文翻译：

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患者对失控的描述和进食发作的大小相互作用影响 ICD-11 暴食症的专家诊断

背景 尽管数据表明“失控”感 (LOC) 是暴饮暴食最突出的方面，但 LOC 的定义在饮食失调评估中差异很大。WHO ICD-11暴饮暴食诊断指南不需要客观大量的食物，这使得准确的LOC诊断变得更加重要。然而，在体重增加和没有补偿行为的情况下评估 LOC 可能特别具有挑战性。这项 ICD-11 现场子研究检查了在令人痛苦的进食发作期间主观体验的描述，结合不同的进食发作大小，如何影响暴食症 (BED) 的诊断。方法 来自世卫组织全球临床实践网络 (N = 192) 的具有饮食失调专业知识的精神卫生专业人员参加了英语、日语，西班牙语。参与者被要求为两个随机分配的病例小插曲选择正确的诊断，并对每个 BED 诊断指南的临床重要性和易用性进行评分。结果 LOC 的存在与发作大小相互作用以预测是否达到正确的诊断结论。如果在典型的令人痛苦的饮食发作期间消耗的量只是主观上比客观上大，临床医生错过 BED 的可能性是正确诊断的 23.1 倍，他们错误诊断其他事物的可能性是正确诊断的 9.7 倍床。此外，如果事件客观上很大，当没有描述 LOC 时，临床医生做出 BED 假阳性诊断的可能性要高 10.8 倍。与跨事件大小的正确诊断可靠关联的 LOC 描述包括两个与已提议的 ICD-11 指南中已包含的内容相似的描述和第三个不相似的描述。LOC 的第三个描述侧重于放弃控制饮食的尝试，因为感觉暴饮暴食是不可避免的。结论 结果强调了在未来指南中详细阐明 LOC 结构的重要性。明确区分 LOC 与令人痛苦和盲目的暴饮暴食可以帮助促进对 BED 与另一种或没有饮食失调的一致和准确的诊断。LOC 的第三个描述侧重于放弃控制饮食的尝试，因为感觉暴饮暴食是不可避免的。结论 结果强调了在未来指南中详细阐明 LOC 结构的重要性。明确区分 LOC 与令人痛苦和盲目的暴饮暴食可以帮助促进对 BED 与另一种或没有饮食失调的一致和准确的诊断。LOC 的第三个描述侧重于放弃控制饮食的尝试，因为感觉暴饮暴食是不可避免的。结论 结果强调了在未来指南中详细阐明 LOC 结构的重要性。明确区分 LOC 与令人痛苦和盲目的暴饮暴食可以帮助促进对 BED 与另一种或没有饮食失调的一致和准确的诊断。