Grilo Carlos M, Ivezaj Valentina, White Marney A
Department of Psychiatry, Yale School of Medicine, United States; Department of Psychology, Yale University, United States.
Department of Psychiatry, Yale School of Medicine, United States.
Behav Res Ther. 2015 Mar;66:72-6. doi: 10.1016/j.brat.2015.01.004. Epub 2015 Feb 3.
Research has examined various aspects of the diagnostic criteria for binge-eating disorder (BED) but has yet to evaluate the DSM-5 severity criterion. This study examined the DSM-5 severity criterion for BED based on binge-eating frequency and tested an alternative severity specifier based on overvaluation of shape/weight. 338 community volunteers categorized with DSM-5 BED completed a battery of self-report instruments. Participants were categorized first using DSM-5 severity levels and second by shape/weight overvaluation and were compared on clinical variables. 264 (78.1%) participants were categorized as mild, 67 (19.8%) as moderate, 6 (1.8%) as severe, and 1 (0.3%) as extreme. Analyses comparing mild and moderate severity groups revealed no significant differences in demographic variables or BMI; the moderate severity group had greater eating-disorder psychopathology (small effect-sizes) but not depression than the mild group. Participants with overvaluation (N = 196; 60.1%) versus without (N = 130; 39.9%) did not differ significantly in age, sex, BMI, or binge-eating frequency. The overvaluation group had significantly greater eating-disorder psychopathology and depression than the non-overvaluation group. The greater eating-disorder and depression levels (medium-to-large effect-sizes) persisted after adjusting for ethnicity/race and binge-eating severity/frequency, without attenuation of effect-sizes. Findings from this non-clinical community sample provide support for overvaluation of shape/weight as a specifier for BED as it provides stronger information about severity than the DSM-5 rating based on binge-eating. Future research should include treatment-seeking patients with BED to test the utility of DSM-5 severity specifiers and include broader clinical validators.
研究已经考察了暴食症（BED）诊断标准的各个方面，但尚未对《精神疾病诊断与统计手册》第五版（DSM-5）的严重程度标准进行评估。本研究基于暴食频率考察了DSM-5中BED的严重程度标准，并测试了基于对体型/体重的过度重视的另一种严重程度说明符。338名被归类为DSM-5 BED的社区志愿者完成了一系列自我报告工具。参与者首先根据DSM-5的严重程度水平进行分类，其次根据对体型/体重的过度重视进行分类，并在临床变量上进行比较。264名（78.1%）参与者被归类为轻度，67名（19.8%）为中度，6名（1.8%）为重度，1名（0.3%）为极重度。比较轻度和中度严重程度组的分析显示，在人口统计学变量或体重指数（BMI）方面没有显著差异；中度严重程度组比轻度组有更严重的饮食失调精神病理学（效应量小），但没有更严重的抑郁。有过度重视（N = 196；60.1%）与没有过度重视（N = 130；39.9%）的参与者在年龄、性别、BMI或暴食频率方面没有显著差异。过度重视组比非过度重视组有显著更严重的饮食失调精神病理学和抑郁。在调整种族/族裔和暴食严重程度/频率后，更高的饮食失调和抑郁水平（效应量为中到大）仍然存在，效应量没有减弱。来自这个非临床社区样本的结果支持将对体型/体重的过度重视作为BED的一种说明符，因为它比基于暴食的DSM-5评级提供了更强的严重程度信息。未来的研究应该纳入寻求治疗的BED患者，以测试DSM-5严重程度说明符的效用，并纳入更广泛的临床验证指标。
