Smith Kathryn E, Ellison Jo M, Crosby Ross D, Engel Scott G, Mitchell James E, Crow Scott J, Peterson Carol B, Le Grange Daniel, Wonderlich Stephen A
Neuropsychiatric Research Institute, Fargo, North Dakota.
Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota.
Int J Eat Disord. 2017 Sep;50(9):1109-1113. doi: 10.1002/eat.22739. Epub 2017 Jun 17.
The DSM-5 includes severity specifiers (i.e., mild, moderate, severe, extreme) for anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED), which are determined by weight status (AN) and frequencies of binge-eating episodes (BED) or inappropriate compensatory behaviors (BN). Given limited data regarding the validity of eating disorder (ED) severity specifiers, this study examined the concurrent and predictive validity of severity specifiers in AN, BN, and BED.
Adults with AN (n = 109), BN (n = 76), and BED (n = 216) were identified from previous datasets. Concurrent validity was assessed by measures of ED psychopathology, depression, anxiety, quality of life, and physical health. Predictive validity was assessed by ED symptoms at the end of the treatment in BN and BED.
Severity categories did not differ in baseline validators, though the mild AN group evidenced greater ED symptoms compared to the severe group. In BN, greater severity was related to greater end of treatment binge-eating and compensatory behaviors, and lower likelihood of abstinence; however, in BED, greater severity was related to lower ED symptoms at the end of the treatment.
Results demonstrated limited support for the validity of DSM-5 severity specifiers. Future research is warranted to explore additional validators and possible alternative indicators of severity in EDs.
《精神疾病诊断与统计手册》第五版（DSM - 5）包括神经性厌食症（AN）、神经性贪食症（BN）和暴饮暴食症（BED）的严重程度说明符（即轻度、中度、重度、极重度），这些说明符由体重状况（AN）以及暴饮暴食发作频率（BED）或不适当的代偿行为（BN）来确定。鉴于关于饮食失调（ED）严重程度说明符有效性的数据有限，本研究考察了AN、BN和BED中严重程度说明符的同时效度和预测效度。
从先前的数据集中识别出患有AN（n = 109）、BN（n = 76）和BED（n = 216）的成年人。通过饮食失调精神病理学、抑郁、焦虑、生活质量和身体健康的测量来评估同时效度。通过BN和BED治疗结束时的饮食失调症状来评估预测效度。
严重程度类别在基线验证指标上没有差异，不过轻度AN组与重度组相比表现出更严重的饮食失调症状。在BN中，更高的严重程度与治疗结束时更多的暴饮暴食和代偿行为以及更低的节制可能性相关；然而，在BED中，更高的严重程度与治疗结束时更低的饮食失调症状相关。
结果显示对DSM - 5严重程度说明符的有效性支持有限。未来的研究有必要探索其他验证指标以及饮食失调严重程度可能的替代指标。
