追求苗条身材为进食障碍提供了一个比 DSM-5 严重程度指标更有意义的替代严重程度指标。
Drive for thinness provides an alternative, more meaningful, severity indicator than the DSM-5 severity indices for eating disorders.
机构信息
Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia.
Ciber Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain.
出版信息
Eur Eat Disord Rev. 2021 May;29(3):482-498. doi: 10.1002/erv.2776. Epub 2020 Sep 22.
OBJECTIVE
To assess an alternative trans-diagnostic indicator for severity based on drive for thinness (DT) for anorexia nervosa (AN), bulimia nervosa (BN), binge-eating disorder (BED), and other specified feeding or eating disorder (OSFED), and to compare this new approach to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) severity categories for EDs.
METHOD
A total of 2,811 ED [428 AN-restrictive (AN-R), 313 AN-binge purging (AN-BP), 1,340 BN, 329 BED, 154 OSFED/atypical AN (AT), and 223 OSFED/purging disorder (PD)] patients were classified using: (a) The DSM-5 severity categories and (b) a DT categorisation. These severity classifications were then compared based on ED symptoms, general psychopathology, personality, and impulsive behaviours.
RESULTS
For the DSM-5 categories, most ED patients fell into the 'mild' to 'moderate' categories. Using the DT categories, AN patients were mainly represented in the 'low' DT category, and BN, OSFED/AT, and PD in the 'high' DT category. The clinically significant findings were stronger for the DT than the DSM-5 severity approach (medium-to-large effect sizes). AN-BP and AN-R provided the most pronounced effects.
CONCLUSION
Our findings question the clinical value of the DSM-5 severity categorisation, and provide initial support for an alternative DT severity approach for AN. HIGHLIGHTS : This study assessed an alternative trans-diagnostic drive for thinness (DT) severity. Category for all eating disorder (ED) sub-types, and then compared this to the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) severity indices for EDs. ED symptoms, general psychopathology, personality, and impulsive behaviours were assessed using both classifications in a total of 2,811 female patients diagnosed with EDs. Clinically significant findings were stronger for the DT than the DSM-5 severity category (medium-to-large effect sizes); there was differentiation of the anorexia nervosa (AN) patients into mainly 'low' DT, and bulimia nervosa (BN) spectrum patients into mainly 'high' DT, vs. most patients were clustered in the 'mild-to-moderate' DSM-5 categories. Our findings provide initial support for an alternative trans-diagnostic DT severity category that may be more clinically meaningful than the DSM-5 severity indices for EDs.
目的
评估一种基于神经性厌食症（AN）、神经性贪食症（BN）、暴食障碍（BED）和其他特定进食或饮食障碍（OSFED）的消瘦驱力（DT）的替代跨诊断严重程度指标，并将这种新方法与精神障碍诊断与统计手册第五版（DSM-5）的 ED 严重程度类别进行比较。
方法
共纳入 2811 名 ED[428 名 AN 限制型（AN-R）、313 名 AN 暴食清除型（AN-BP）、1340 名 BN、329 名 BED、154 名 OSFED/非典型 AN（AT）和 223 名 OSFED/清除障碍（PD）]患者，分类标准为：（a）DSM-5 严重程度类别和（b）DT 分类。然后根据 ED 症状、一般精神病理学、人格和冲动行为对这些严重程度分类进行比较。
结果
对于 DSM-5 类别，大多数 ED 患者被归入“轻度”到“中度”类别。使用 DT 分类，AN 患者主要归入“低”DT 类别，而 BN、OSFED/AT 和 PD 归入“高”DT 类别。DT 严重程度分类的临床显著发现强于 DSM-5 严重程度分类（中到大效应量）。AN-BP 和 AN-R 提供了最明显的效果。
结论
我们的研究结果对 DSM-5 严重程度分类的临床价值提出了质疑，并为 AN 的替代 DT 严重程度分类提供了初步支持。
要点
本研究评估了一种用于所有饮食障碍（ED）亚型的替代跨诊断消瘦驱力（DT）严重程度分类，并将其与精神障碍诊断与统计手册第五版（DSM-5）ED 严重程度指数进行比较。使用这两种分类方法，共评估了 2811 名被诊断为 ED 的女性患者的 ED 症状、一般精神病理学、人格和冲动行为。DT 严重程度分类的临床显著发现强于 DSM-5 严重程度类别（中到大效应量）；AN 患者主要归入“低”DT 类别，而 BN 谱障碍患者主要归入“高”DT 类别，而大多数患者则归入 DSM-5“轻度到中度”类别。我们的研究结果为替代跨诊断 DT 严重程度分类提供了初步支持，与 DSM-5 严重程度指数相比，该分类可能更具有临床意义。
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