Goldschmidt Andrea B, Accurso Erin C, Crosby Ross D, Cao Li, Ellison Jo, Smith Tracey L, Klein Marjorie H, Mitchell James E, Crow Scott J, Wonderlich Stephen A, Peterson Carol B
Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA.
Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA.
Appetite. 2016 Dec 1;107:471-477. doi: 10.1016/j.appet.2016.08.104. Epub 2016 Aug 20.
Although loss of control (LOC) while eating is a core construct of bulimia nervosa (BN), questions remain regarding its validity and prognostic significance independent of overeating. We examined trajectories of objective and subjective binge eating (OBE and SBE, respectively; i.e., LOC eating episodes involving an objectively or subjectively large amount of food) among adults participating in psychological treatments for BN-spectrum disorders (n = 80). We also explored whether changes in the frequency of these eating episodes differentially predicted changes in eating-related and general psychopathology and, conversely, whether changes in eating-related and general psychopathology predicted differential changes in the frequency of these eating episodes. Linear mixed models with repeated measures revealed that OBE decreased twice as rapidly as SBE throughout treatment and 4-month follow-up. Generalized linear models revealed that baseline to end-of-treatment reductions in SBE frequency predicted baseline to 4-month follow-up changes in eating-related psychopathology, depression, and anxiety, while changes in OBE frequency were not predictive of psychopathology at 4-month follow-up. Zero-inflation models indicated that baseline to end-of-treatment changes in eating-related psychopathology and depression symptoms predicted baseline to 4-month follow-up changes in OBE frequency, while changes in anxiety and self-esteem did not. Baseline to end-of-treatment changes in eating-related psychopathology, self-esteem, and anxiety predicted baseline to 4-month follow-up changes in SBE frequency, while baseline to end-of-treatment changes in depression did not. Based on these findings, LOC accompanied by objective overeating may reflect distress at having consumed an objectively large amount of food, whereas LOC accompanied by subjective overeating may reflect more generalized distress related to one's eating- and mood-related psychopathology. BN treatments should comprehensively target LOC eating and related psychopathology, particularly in the context of subjectively large episodes, to improve global outcomes.
尽管进食时失控（LOC）是神经性贪食症（BN）的核心构成要素，但关于其有效性以及独立于暴饮暴食之外的预后意义仍存在疑问。我们研究了参与BN谱系障碍心理治疗的成年人（n = 80）中客观和主观暴饮暴食（分别为OBE和SBE，即涉及客观或主观大量食物的LOC进食发作）的轨迹。我们还探讨了这些进食发作频率的变化是否能不同程度地预测进食相关和一般精神病理学的变化，反之，进食相关和一般精神病理学的变化是否能预测这些进食发作频率的不同变化。重复测量的线性混合模型显示，在整个治疗过程和4个月的随访中，OBE下降的速度是SBE的两倍。广义线性模型显示，从基线到治疗结束时SBE频率的降低预测了从基线到4个月随访时进食相关精神病理学、抑郁和焦虑的变化，而OBE频率的变化在4个月随访时不能预测精神病理学。零膨胀模型表明，从基线到治疗结束时进食相关精神病理学和抑郁症状的变化预测了从基线到4个月随访时OBE频率的变化，而焦虑和自尊的变化则不能。从基线到治疗结束时进食相关精神病理学、自尊和焦虑的变化预测了从基线到4个月随访时SBE频率的变化，而从基线到治疗结束时抑郁的变化则不能。基于这些发现，伴有客观暴饮暴食的LOC可能反映了摄入客观大量食物后的痛苦，而伴有主观暴饮暴食的LOC可能反映了与一个人的进食和情绪相关精神病理学更普遍的痛苦。BN治疗应全面针对LOC进食和相关精神病理学，特别是在主观大量发作的情况下，以改善整体预后。
