Eddy Kamryn T, Keel Pamela K, Dorer David J, Delinsky Sherrie S, Franko Debra L, Herzog David B
Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
Int J Eat Disord. 2002 Mar;31(2):191-201. doi: 10.1002/eat.10016.
To compare patients with restricting anorexia nervosa (ANR) and binge/purge anorexia nervosa (ANBP) on measures of impulsivity, course, and outcome.
One hundred thirty-six treatment-seeking women with AN followed prospectively for 8-12 years were reclassified at intake as 51 ANRs and 85 ANBPs according to the DSM-IV subtyping classification. Lifetime Axis I and Axis II disorders were assessed using structured interviews; follow-up interviews were conducted at 6-12-month intervals to collect weekly data on eating disorder symptomatology.
Women with ANR and ANBP did not differ on history of substance abuse, kleptomania, suicidality, or borderline personality diagnosis at intake, or on rates of recovery, relapse, or mortality. By 8 years of follow-up, 62% of women with ANR crossed over to ANBP prospectively and only 12% of women with AN never reported regular binge/purge behaviors.
The findings on impulsivity, course, and outcome do not support the current subtyping system. The high crossover rate in our sample from ANR to ANBP suggests that ANR represents a phase in the course of AN rather than a distinct subtype.
比较限制型神经性厌食症（ANR）患者和暴饮暴食/清除型神经性厌食症（ANBP）患者在冲动性、病程和结局方面的情况。
136名寻求治疗的神经性厌食症女性患者接受了为期8至12年的前瞻性随访，根据《精神疾病诊断与统计手册》第四版（DSM-IV）的亚型分类，在入院时重新分类为51名ANR患者和85名ANBP患者。使用结构化访谈评估终生轴I和轴II障碍；每隔6至12个月进行一次随访访谈，以收集关于饮食失调症状的每周数据。
ANR患者和ANBP患者在入院时的药物滥用史、盗窃癖、自杀倾向或边缘性人格诊断方面，以及在康复、复发或死亡率方面没有差异。到随访8年时，62%的ANR患者前瞻性地转变为ANBP患者，只有12%的神经性厌食症女性从未报告过规律的暴饮暴食/清除行为。
关于冲动性、病程和结局的研究结果不支持当前的亚型分类系统。我们样本中从ANR到ANBP的高转变率表明，ANR代表神经性厌食症病程中的一个阶段，而不是一个独特的亚型。
