Eddy Kamryn T, Crosby Ross D, Keel Pamela K, Wonderlich Stephen A, le Grange Daniel, Hill Laura, Powers Pauline, Mitchell James E
Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02214, USA.
J Nerv Ment Dis. 2009 Jan;197(1):41-9. doi: 10.1097/NMD.0b013e3181927389.
Identified problems with the classification system of eating disorders (EDs), including its imperfect application to clinical samples, challenge its validity and limit its utility. The present study aimed to empirically identify and validate ED phenotypes in a multisite clinical sample using latent profile analysis (LPA). ED symptom data collected from 687 individuals were included in LPA. Identified latent profiles (LPs) were compared on clinical validators. Five LPs were identified: LP1 (n = 178), objective bingeing and multiple purging methods; LP2 (n = 172), objective bingeing without purging; LP3 (n = 130), objective bingeing and vomiting; LP4 (n = 108), low/normal weight and excessive exercise; LP5 (n = 99), low/normal weight and absence of ED symptoms. Validation analyses demonstrated the most extreme psychopathology/medical morbidity in LP1 and the least in LP5. LP1 and LP3 were most likely to report medication treatment for EDs. Identified LPs imperfectly resembled diagnostic and statistical manual of mental disorders-IV-TR EDs. Multiple purging methods and the absence of ED cognitions marked differences in severity across groups, whereas low weight did not. Clinical differences in psychopathology, medical morbidity, and treatment utilization validated groups. Future research should examine longitudinal stability of empirically-derived phenotypes and incremental validity of alternative classification schema to inform DSM-V.
已发现饮食失调（EDs）分类系统存在的问题，包括其在临床样本中的应用不完善，这对其有效性提出了挑战并限制了其效用。本研究旨在通过潜在类别分析（LPA），在多地点临床样本中实证识别和验证EDs的表型。从687名个体收集的ED症状数据被纳入LPA。在临床验证指标上对识别出的潜在类别（LPs）进行比较。识别出了五个潜在类别：潜在类别1（n = 178），客观暴饮暴食和多种清除方法；潜在类别2（n = 172），客观暴饮暴食但无清除行为；潜在类别3（n = 130），客观暴饮暴食和呕吐；潜在类别4（n = 108），低/正常体重和过度运动；潜在类别5（n = 99），低/正常体重且无ED症状。验证分析表明，潜在类别1的精神病理学/医学发病率最为极端，潜在类别5的发病率最低。潜在类别1和潜在类别3最有可能报告针对EDs的药物治疗。识别出的潜在类别与《精神障碍诊断与统计手册》第四版修订版（DSM-IV-TR）中的EDs并不完全相似。多种清除方法以及缺乏ED认知标志着不同组之间严重程度的差异，而低体重则不然。精神病理学、医学发病率和治疗利用方面的临床差异验证了这些类别。未来的研究应检验实证得出的表型的纵向稳定性以及替代分类模式的增量效度，以为《精神障碍诊断与统计手册》第五版（DSM-V）提供参考。
