Forney K Jean, Rezeppa Taylor L, Hill Naomi G, Bodell Lindsay P, Brown Tiffany A
Department of Psychology, Ohio University, Athens, Ohio, USA.
Department of Psychology, Western University, London, Ontario, Canada.
Int J Eat Disord. 2024 Apr;57(4):839-847. doi: 10.1002/eat.24122. Epub 2024 Jan 2.
Some individuals meet the criteria for atypical anorexia nervosa and another eating disorder simultaneously. The current study evaluated whether allowing a diagnosis of atypical anorexia nervosa to supersede a diagnosis of bulimia nervosa (BN) or binge-eating disorder (BED) provided additional information on psychological functioning.
Archival data from 650 university students (87.7% female, 69.4% white) who met Eating Disorder Diagnostic Survey for DSM-5 eating disorder criteria and completed questionnaires assessing quality of life, eating disorder-related impairment, and/or eating pathology at a single time point. Separate regression models used diagnostic category to predict quality of life and impairment. Two diagnostic schemes were used: the DSM-5 diagnostic scheme and an alternative scheme where atypical anorexia nervosa superseded all diagnoses except anorexia nervosa. Model fit was compared using the Davidson-Mackinnon J test. Analyses were pre-registered (https://osf.io/2ejcd).
Allowing an atypical anorexia nervosa diagnosis to supersede a BN or BED diagnosis provided better fit to the data for eating disorder-related impairment (p = .02; n = 271), but not physical, psychological, or social quality of life (p's ≥ .33; n = 306). Allowing an atypical anorexia nervosa diagnosis to supersede a BN or BED diagnosis provided a better fit in cross-sectional models predicting purging (p = .02; n = 638), but not body dissatisfaction, binge eating, restricting, or excessive exercise (p's ≥ .08; n's = 633-647).
The current data support retaining the DSM-5 diagnostic scheme. More longitudinal work is needed to understand the predictive validity of the atypical anorexia nervosa diagnosis.
The current study examined how changes to the diagnostic categories for eating disorders may change how diagnoses are associated with quality of life and impairment. Overall, findings suggest that the diagnostic hierarchy should be maintained.
一些个体同时符合非典型神经性厌食症和另一种饮食失调的标准。本研究评估了允许非典型神经性厌食症的诊断取代神经性贪食症（BN）或暴饮暴食障碍（BED）的诊断是否能提供有关心理功能的更多信息。
来自650名大学生（87.7%为女性，69.4%为白人）的档案数据，这些学生符合《精神疾病诊断与统计手册》第5版（DSM-5）饮食失调诊断标准，并在单一时间点完成了评估生活质量、饮食失调相关损害和/或饮食病理学的问卷。使用单独的回归模型，以诊断类别来预测生活质量和损害。使用了两种诊断方案：DSM-5诊断方案和一种替代方案，即非典型神经性厌食症取代除神经性厌食症之外的所有诊断。使用戴维森-麦金农J检验比较模型拟合度。分析已预先注册（https://osf.io/2ejcd）。
允许非典型神经性厌食症的诊断取代BN或BED的诊断，对于饮食失调相关损害的数据拟合更好（p = 0.02；n = 271），但对于身体、心理或社会生活质量则不然（p值≥0.33；n = 306）。允许非典型神经性厌食症的诊断取代BN或BED的诊断，在预测催吐行为的横断面模型中拟合更好（p = 0.02；n = 638），但对于身体不满、暴饮暴食、节食或过度运动则不然（p值≥0.08；n值 = 633 - 647）。
当前数据支持保留DSM-5诊断方案。需要更多纵向研究来了解非典型神经性厌食症诊断的预测效度。
本研究探讨了饮食失调诊断类别的变化如何改变诊断与生活质量和损害之间的关联。总体而言，研究结果表明应维持诊断等级。
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