Brown School, Washington University in St. Louis, St. Louis, Missouri, USA.
Eur Eat Disord Rev. 2020 Nov;28(6):709-723. doi: 10.1002/erv.2767. Epub 2020 Aug 3.
Eating disorders (EDs) have high rates of psychiatric comorbidity. This study aimed to characterize longitudinal patterns of comorbidities in adults with EDs.
Sequence analysis and hierarchical clustering were applied to ages of onset and recency for select eating, substance, mood, and anxiety disorders from the 479 participants in the Collaborative Psychiatric Epidemiology Surveys with lifetime DSM-IV bulimia nervosa, binge eating disorder, or anorexia nervosa. External validators were compared across clusters using chi-square tests.
Five clusters were identified among individuals with any lifetime ED based on longitudinal sequence of psychiatric disorder onset and remission, characterized as: (1) multi-comorbid with early onset of comorbid disorder (46%); (2) moderate preeminent anxiety with moderate comorbidity and low ED persistence (20%); (3) late ED onset with low comorbidity (15%); (4) early onset, persistent ED with low comorbidity (14%); and (5) chronic, early onset depression (5%). Clusters were well differentiated by significant differences in age, body mass index, race, and psychiatric indicators.
This study demonstrates a new method to assess clustering of comorbidity among individuals with lifetime EDs. Having a psychiatric diagnosis prior to an ED was associated with greater psychopathology and illness duration. Information on timing of diagnoses may allow for more refined comorbidity classification.
饮食失调（ED）的精神共病率很高。本研究旨在描述 ED 成人共病的纵向模式。
对来自 479 名有终身 DSM-IV 神经性贪食症、暴食障碍或神经性厌食症的合作精神流行病学调查参与者的特定饮食、物质、情绪和焦虑障碍的发病年龄和最近发病年龄，应用序列分析和层次聚类进行分析。使用卡方检验比较聚类之间的外部验证器。
根据精神障碍发病和缓解的纵向序列，在任何有终身 ED 的个体中确定了五个聚类，特征为：（1）多共病，共病障碍发病早（46%）；（2）显著焦虑，共病和 ED 持续时间低（20%）；（3）ED 发病晚，共病低（15%）；（4）ED 早发，持续时间长，共病低（14%）；（5）慢性，早发性抑郁（5%）。聚类在年龄、体重指数、种族和精神指标方面存在显著差异，因此得以很好地区分。
本研究展示了一种评估终生 ED 个体共病聚类的新方法。在 ED 之前有精神诊断与更多的精神病理学和疾病持续时间相关。关于诊断时间的信息可能允许更精细的共病分类。
