Eating Disorder Diagnostic Crossover: A Meta‐Analysis
Aspen Martin, Casey Stern, Milena S. Carpati, Rebecca Berg, Dante Ascarrunz, Leanne Quigley, Peter Franz, Margaret SalaABSTRACT
Objective
Diagnostic crossover among eating disorders (EDs) is clinically important, yet rates are inconsistently quantified. This meta‐analysis aims to quantify the frequency and direction of diagnostic crossover among EDs (both within‐syndrome and between‐syndrome), to evaluate study‐level moderators of crossover rates, and to conduct a formal appraisal of the quality of the included studies.
Method
A literature search was conducted following PRISMA 2020 guidelines, including all relevant articles on PsycINFO, Pubmed/Medline, and ProQuest Dissertations & Theses Global databases from inception to June 10, 2026. Twenty‐seven studies (24 samples; 287 effect sizes) were synthesized using random‐effects models. Mixed‐effects models tested diagnostic criteria, follow‐up duration, treatment setting, diagnostic method, and demographics as moderators.
Results
Between‐syndrome crossovers (e.g., bulimia nervosa [BN] to anorexia nervosa [AN]) were rare, ranging from 0% (e.g., AN to binge eating disorder [BED]) to 13% (e.g., BED to BN), whereas within‐syndrome shifts such as AN subtype shifts (23% from restrictive to binge‐purging type) and transitions into other specified feeding or eating disorder (OSFED)/eating disorder not otherwise specified (EDNOS) were more common (17% to 25% across syndromes). Diagnostic criteria and method were significant moderators.
Discussion
Diagnostic instability reflects within‐AN shifts and OSFED/EDNOS transitions more than between‐syndrome crossovers, underscoring the value of repeated specialist, interview‐based reassessment.