Prospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatr. Jul 19, 2021; 11(7): 375-387
Published online Jul 19, 2021. doi: 10.5498/wjp.v11.i7.375
Classification of subtypes of patients with eating disorders by correspondence analysis
Josune Martín, Ane Anton-Ladislao, Ángel Padierna, Belén Berjano, José María Quintana
Josune Martín, Ane Anton-Ladislao, José María Quintana, Department of Research, Galdakao-Usansolo Hospital, Galdakao 48960, Spain
Josune Martín, Kronikgune Institute for Health Services Research, Barakaldo 48902, Spain
Josune Martín, Ángel Padierna, José María Quintana, Health Services Research on Chronic Diseases Network – REDISSEC, Galdakao 48960, Spain
Ángel Padierna, Belén Berjano, Department of Psychiatry, Galdakao-Usansolo Hospital, Galdakao 48960, Spain
Author contributions: Martín J, Padierna A, and Quintana JM designed the study; Martín J, Padierna A and Berjano B performed the data collection; Martín J and Antón-Ladislao A performed data analyses; Martín J and Padierna A were responsible for manuscript writing; all the authors contributed to interpreting the data; and all authors read and approved the final manuscript.
Supported by the Carlos III Health Institute Project “Adaptation and Validation of the Clinical Assessment Inventory for Eating Disorders”, No. PI09/90832.
Institutional review board statement: The study was approved by the Ethics Committee of the Galdakao-Usansolo Hospital.
Clinical trial registration statement: The clinical trial is registered with, using identifier NCT02483117. Details can be found at
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors of this manuscript having no conflicts of interest to disclose.
Data sharing statement: There is no additional data available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Josune Martín, PhD, Research Scientist, Department of Research, Galdakao-Usansolo Hospital, B Labeaga s/n, Galdakao 48960, Spain.
Received: February 8, 2021
Peer-review started: February 8, 2021
First decision: March 30, 2021
Revised: April 9, 2021
Accepted: June 16, 2021
Article in press: June 16, 2021
Published online: July 19, 2021
Research background

Eating disorders (ED) pose special problems for patients and have serious implications, including impaired health, psychiatric comorbidity and poor quality of life. Some authors assert that there is heterogeneity in clinical presentations that characterize patients with ED. It is relevant to research subtypes of ED, and these groupings might possibly be used to inform assessment, treatment and future diagnostic nosologies.

Research motivation

This is the first study to apply multiple correspondence analysis to EDs diagnostic data and to use cluster analysis (CA) in such detail to search for EDs patient groups in this area.

Research objectives

The aim of our study was to characterize groups of patients with ED into subtypes according to sociodemographic and psychosocial impairment data using multiple correspondence analysis (MCA), and to validate the results using several illustrative variables and arrive at a classification of the subjects that is suggested by the data, rather being defined a priori, where subjects in each group are similar to one another but dissimilar to those from other groups.

Research methods

This study involved ED patients, who were receiving psychiatric care at the Hospital Galdakao-Usansolo in Biscay, Spain, all of whom were informed of the nature of this research by their psychiatrist before agreeing to participate. MCA provides descriptive patterns based on categories of the original variables, and CA organizes information from apparently heterogeneous individuals into relatively homogeneous groups based on their values in different variables.

Research results

Of 176 ED patients were differentiated into well-defined outcome groups according to specific clusters of compensating behaviours. Types D and A were similar with respect to sociodemographic data, while types D and B were similar with respect to psychosocial impairment variables. Types B and D had the least severe ED (according to psychosocial impairment variables); Types A and C had the most severe.

Research conclusions

In our study, the MCA methodology shows groups that are more discriminating, i.e., patients of each group (A, B, C, D) are more similar or homogeneous among themselves and dissimilar or heterogeneous among the different groups. A technique such as MCA synthesizes information on the original variables into a small number of components, making data interpretation easier and more viable.

Research perspectives

Grouping ED patients into subtypes could help improve the establishment of more effective diagnostic and treatment strategies, and improve patient care and prognosis in clinical practice.