Walsh B Timothy, Hagan Kelsey E, Lockwood Carlin
Department of Psychiatry, New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, New York, USA.
Pritzker School of Medicine, The University of Chicago, Chicago, Illinois, USA.
Int J Eat Disord. 2023 Apr;56(4):798-820. doi: 10.1002/eat.23856. Epub 2022 Dec 12.
A description of atypical anorexia nervosa (atypical AN) was provided in DSM-5 in 2013 and a sizable literature has since developed describing the clinical features of individuals with atypical AN and comparing them to those of individuals with anorexia nervosa (AN) and those of healthy individuals. The purpose of this study was to conduct a systematic review of this literature.
A systematic review following PRISMA guidelines was conducted of studies published since 2013 that compared the clinical characteristics of individuals with atypical AN to those of individuals with AN and/or healthy controls. Meta-analyses were conducted when similar measures were reported in three or more studies.
Twenty-four publications met criteria for inclusion. Their results indicated that the level of eating disorder-specific psychopathology is significantly higher among individuals with atypical AN than among controls and as high or higher as among individuals with AN while levels of non-eating disorder psychopathology are similar. Individuals with atypical AN experience many of the physiological complications associated with AN, but some complications appear less frequent.
The psychological symptoms and physiological complications of individuals with atypical AN are generally similar to those of individuals with AN, although there may be differences in the frequency of some physical complications. Little information is available on the course, outcome, and treatment response of individuals with atypical AN. In addition, full diagnostic criteria for atypical AN have not been developed, and the nosological relationship of atypical AN to established eating disorders such as bulimia nervosa is unclear.
Atypical anorexia nervosa as described in the DSM-5 identifies individuals with many of the psychological characteristics of typical anorexia nervosa who, despite significant weight loss, are not underweight. The current systematic review found that the psychological symptoms and physiological characteristics of individuals with atypical AN are generally similar to those of individuals with AN, although there may be differences in the frequency of some physical complications.
2013年《精神疾病诊断与统计手册》第五版（DSM - 5）对非典型神经性厌食症（非典型AN）进行了描述，此后出现了大量文献，描述了非典型AN患者的临床特征，并将其与神经性厌食症（AN）患者及健康个体的特征进行比较。本研究的目的是对该文献进行系统综述。
按照PRISMA指南对2013年以来发表的将非典型AN患者的临床特征与AN患者和/或健康对照者的临床特征进行比较的研究进行系统综述。当三项或更多研究报告了相似的测量方法时，进行荟萃分析。
24篇出版物符合纳入标准。其结果表明，非典型AN患者的饮食失调特异性精神病理学水平显著高于对照组，与AN患者相当或更高，而非饮食失调精神病理学水平相似。非典型AN患者会经历许多与AN相关的生理并发症，但有些并发症出现的频率较低。
非典型AN患者的心理症状和生理并发症通常与AN患者相似，尽管某些身体并发症的发生频率可能存在差异。关于非典型AN患者的病程、结局和治疗反应的信息很少。此外，非典型AN的完整诊断标准尚未制定，非典型AN与诸如神经性贪食症等既定饮食失调症的疾病关系尚不清楚。
DSM - 5中描述的非典型神经性厌食症识别出了许多具有典型神经性厌食症心理特征的个体，这些个体尽管体重显著减轻，但并未体重过低。当前的系统综述发现，非典型AN患者的心理症状和生理特征通常与AN患者相似，尽管某些身体并发症的发生频率可能存在差异。
