School of Psychology, University of Minho, Braga, Portugal.
Department of Psychiatry & Human Behavior, Warren Alpert Medical School of Brown University/The Miriam Hospital, Providence, RI, USA.
Eur Eat Disord Rev. 2020 Jul;28(4):423-432. doi: 10.1002/erv.2737. Epub 2020 Apr 3.
This study investigated the utility of DSM-5 indicators of loss of control (LOC) eating in adult bariatric surgery patients who presented with binge-eating episodes.
Participants (all women) were 40 preoperative and 28 postoperative bariatric surgery patients reporting objective binge eating (OBE), 46 preoperative and 52 postoperative with subjective binge-eating (SBE), 53 bulimia nervosa (BN) controls, and 34 binge-eating disorder (BED) controls. Face-to-face Eating Disorder Examination interviews and questionnaires were administered. ANOVA, T-test, χ , and regressions compared the groups in terms of LOC indicators endorsed and to explain disordered eating psychopathology.
The indicator most commonly reported by bariatric patients with OBE was "feeling disgusted" (90% and 75% of pre- and postoperative groups), and the least endorsed was "eating alone" (40 and 28.6%). These indicators were reported by >84.9% of the BN and BED. Bariatric patients (pre- or post-surgery) with OBE only reported a higher number of indicators than patients with SBE only (t(150) = 2.34, p = .021). A higher number of indicators reported were associated with increased eating-related psychopathology (F(1,134) = 31.06, p < .001), but only for the post-surgery patients.
The LOC indicators proposed by DSM-5 need to be refined or revised for the bariatric population. Highlights Bariatric patients endorse fewer LOC indicators than BN or BED during a binge-eating episode. Some of the DSM-5 LOC indicators may not be suited to assess episodes of loss of control eating among bariatric patients. The Higher the number of LOC indicators reported, the higher the eating-related psychopathology.
本研究旨在探讨 DSM-5 中关于失控进食（LOC）的指标在出现暴食发作的成年减重手术患者中的应用价值。
参与者均为女性，包括 40 名术前和 28 名术后行减重手术且报告存在客观暴食（OBE）的患者、46 名术前和 52 名术后报告存在主观暴食（SBE）的患者、53 名神经性贪食症（BN）对照者和 34 名暴食障碍（BED）对照者。通过面对面的进食障碍检查访谈和问卷调查对所有参与者进行评估。采用方差分析、T 检验、卡方检验和回归分析比较各组报告的 LOC 指标，以及解释紊乱进食的心理病理。
接受减重手术且存在 OBE 的患者中最常报告的 LOC 指标是“感到厌恶”（术前和术后组分别为 90%和 75%），报告比例最低的是“独自进食”（40%和 28.6%）。这些指标也被>84.9%的 BN 和 BED 报告。仅存在 OBE 的减重患者（术前或术后）报告的 LOC 指标数多于仅存在 SBE 的患者（t(150)=2.34，p=0.021）。报告的 LOC 指标数与进食相关心理病理的增加呈正相关（F(1,134)=31.06，p<0.001），但仅在术后患者中存在这种相关性。
DSM-5 提出的 LOC 指标需要进一步细化或修订，以适用于减重人群。要点 与 BN 或 BED 相比，在暴食发作期间，减重患者报告的 LOC 指标更少。DSM-5 中某些 LOC 指标可能不适用于评估减重患者的失控进食发作。报告的 LOC 指标数越多，与进食相关的心理病理越严重。
