Unit of Epidemiology and Biostatistics, Institute of Clinical Physiology, National Research Council, Pisa, Italy.
IRCCS Stella Maris Foundation, Pisa, Italy.
Eur Psychiatry. 2018 Mar;49:81-93. doi: 10.1016/j.eurpsy.2017.12.024. Epub 2018 Feb 6.
The transdiagnostic model of eating disorders (ED) proposes common cognitive mechanisms in patients with ED psychopathology. Little is known about their role in the maintenance of ED in children and adolescents. This study aimed to determine whether the relationships between key factors (low self-esteem, weight and shape control, clinical perfectionism, interpersonal problems, distress and mood instability) and core maintaining mechanisms (binge-eating and restraint) would support a transdiagnostic theory in young patients.
A total of 419 patients (mean age 14.7 ± 2.14 years; age range: 7-18 years; males 13.8%) diagnosed with an ED were assessed in six Italian clinical centers in 2013. Multiple comparisons between ED diagnosis, correlation analysis and principal component analysis (PCA) were performed.
Of the entire collective, 51.5% of patients were diagnosed with Anorexia Nervosa (AN), 12.3% were diagnosed with Bulimia Nervosa (BN) and 36.2% with Eating Disorder Not Otherwise Specified (EDNOS). In PCA, the core ED mechanisms, dietary restraint and binge eating, acted as poles of attraction of the other variables. The AN group was particularly linked to restraint and the BN group was particularly related to "Bulimia". Considering the diagnostic subtypes, there were no significant differences between the anorexic binge-purging group, bulimic purging group and bulimic non-purging group, which constituted a unique cluster related to affective, interpersonal problems and to perfectionism, indicating a very homogeneous subgroup. Restricting anorexic group (AN-R), related to shape concern and anxious-depressed mood, was not linked to the other subtypes. EDNOS appeared to be opposed to the AN-R group; the binge eating disorder group appeared to be independent from others.
Our results suggest the presence of both specific and transdiagnostic mechanisms in ED subtypes, whose knowledge is of relevance for clinical practice.
饮食失调(transdiagnostic)的跨诊断模型提出了饮食失调患者心理病理学中的共同认知机制。关于这些机制在儿童和青少年饮食失调中的维持作用，我们知之甚少。本研究旨在确定关键因素（低自尊、体重和体型控制、临床完美主义、人际问题、痛苦和情绪不稳定）与核心维持机制（暴食和节食）之间的关系是否支持年轻患者的跨诊断理论。
2013 年，我们在意大利六个临床中心评估了 419 名被诊断为 ED 的患者（平均年龄 14.7±2.14 岁，年龄范围：7-18 岁，男性占 13.8%）。对 ED 诊断进行了多次比较，进行了相关分析和主成分分析（PCA）。
在整个队列中，51.5%的患者被诊断为神经性厌食症（AN），12.3%的患者被诊断为神经性贪食症（BN），36.2%的患者被诊断为未特定的饮食失调（EDNOS）。在 PCA 中，核心 ED 机制，即饮食限制和暴食，是其他变量的吸引中心。AN 组与限制饮食特别相关，BN 组与“贪食”特别相关。考虑到诊断亚型，神经性暴食-清除组、贪食清除组和贪食非清除组之间没有显著差异，它们构成了一个与情感、人际问题和完美主义相关的独特聚类，表明存在一个非常同质的亚组。限制型神经性厌食症组（AN-R）与体型关注和焦虑抑郁情绪相关，与其他亚型没有关联。EDNOS 似乎与 AN-R 组相反；暴食障碍组似乎与其他组独立。
我们的研究结果表明，在 ED 亚型中存在特定和跨诊断的机制，这些机制的知识对于临床实践具有重要意义。
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