Oregon Research Institute, Eugene, OR 97403, USA.
J Abnorm Psychol. 2013 May;122(2):445-57. doi: 10.1037/a0030679. Epub 2012 Nov 12.
We examined prevalence, incidence, impairment, duration, and course for the proposed DSM-5 eating disorders in a community sample of 496 adolescent females who completed annual diagnostic interviews over 8 years. Lifetime prevalence by age 20 was 0.8% for anorexia nervosa (AN), 2.6% for bulimia nervosa (BN), 3.0% for binge eating disorder (BED), 2.8% for atypical AN, 4.4% for subthreshold BN, 3.6% for subthreshold BED, 3.4% for purging disorder (PD), and combined prevalence of 13.1% (5.2% had AN, BN, or BED; 11.5% had feeding and eating disorders not elsewhere classified; FED-NEC). Peak onset age was 19-20 for AN, 16-20 for BN, and 18-20 for BED, PD, and FED-NEC. Youth with these eating disorders typically reported greater functional impairment, distress, suicidality, mental health treatment, and unhealthy body mass index, though effect sizes were relatively smaller for atypical AN, subthreshold BN, and PD. Average episode duration in months ranged from 2.9 for BN to 11.2 for atypical AN. One-year remission rates ranged from 71% for atypical AN to 100% for BN, subthreshold BN, and BED. Recurrence rates ranged from 6% for PD to 33% for BED and subthrehold BED. Diagnostic progression from subthreshold to threshold eating disorders was higher for BN and BED (32% and 28%) than for AN (0%), suggesting some sort of escalation mechanism for binge eating. Diagnostic crossover was greatest from BED to BN. Results imply that the new DSM-5 eating disorder criteria capture clinically significant psychopathology and usefully assign eating disordered individuals to homogeneous diagnostic categories.
我们在一个社区样本中对 496 名女性青少年进行了为期 8 年的年度诊断访谈，研究了 DSM-5 中提出的进食障碍的患病率、发病率、功能损害、病程和转归。到 20 岁时，神经性厌食症（AN）的终生患病率为 0.8%，神经性贪食症（BN）为 2.6%，暴食障碍（BED）为 3.0%，非典型 AN 为 2.8%，阈下 BN 为 4.4%，阈下 BED 为 3.6%，清除障碍（PD）为 3.4%，总患病率为 13.1%（5.2%患有 AN、BN 或 BED；11.5%患有未在其他地方分类的进食和进食障碍；FED-NEC）。发病高峰年龄为 AN 为 19-20 岁，BN 为 16-20 岁，BED、PD 和 FED-NEC 为 18-20 岁。患有这些进食障碍的青少年通常报告有更大的功能损害、痛苦、自杀意念、心理健康治疗和不健康的体重指数，尽管非典型 AN、阈下 BN 和 PD 的效应量相对较小。病程以月计，BN 为 2.9 个月，非典型 AN 为 11.2 个月。一年缓解率从非典型 AN 的 71%到 BN、阈下 BN 和 BED 的 100%不等。复发率从 PD 的 6%到 BED 和阈下 BED 的 33%不等。从阈下到阈值进食障碍的诊断进展在 BN 和 BED 中更高（分别为 32%和 28%），而非典型 AN 中为 0%，这表明暴饮暴食存在某种升级机制。从 BED 到 BN 的诊断交叉最大。研究结果表明，新的 DSM-5 进食障碍标准捕捉到了临床上有意义的精神病理学，并有助于将进食障碍患者归入同质的诊断类别。
