Beyond diagnostic boundaries: A multidimensional model of established and emerging eating-related psychopathology

Background: Current nosographic systems, which include chapters dedicated to eating disorders (EDs), offer clinically useful criteria but insufficiently address symptom overlap, heterogeneity within the same diagnosis, or its changes in time, and emerging or context-dependent eating-related phenotypes (ERP). Therefore, a transdiagnostic dimensional approach may be useful because it can describe, in a more nuanced manner, the psychopathological processes shared across various clinical presentations. Objectives: To develop a dimensional eating psychopathology framework as a hypothesis-generating instrument for characterizing established EDs and emerging or context-dependent ERPs. Methods: A conceptual model-development approach was applied for extending a previously proposed integrative classification of EDs and related phenomena. A set of hypothesized dimensions was selected according to their transdiagnostic applicability, dimensional nature, conceptual distinction from diagnostic labels, and potential clinical relevance. Characteristics describing the circumstances in which psychopathology is expressed were represented separately as contextual modifiers. Applying this framework, 15 ERPs were mapped theoretically across eight dimensions using a five-level ordinal scale. Results: The proposed model is composed of eight core dimensions: body-image overvaluation, restrictive dietary control, loss of control over eating, compulsivity and cognitive rigidity, reward/addiction-like eating, emotion-regulation dependence, interoceptive dysregulation, and compensatory or body-modifying behavior. Six contextual factors with modifying properties were identified, i.e., circadian/sleep, medical treatment, substance use, reproductive, athletic/performance, and health/purity-related contexts. Conclusions: The currently proposed model offers a common descriptive framework for comparing recognized EDs, emerging constructs, behavioral phenotypes, and context-dependent presentations without implying equivalent diagnostic status. In its early stages of development, the model requires formal content validation, independent expert assessment, and patient-level empirical testing before it can be used as a classification or clinical instrument.