Tomba E, Tecuta L, Gardini V, Tomei G, Lo Dato E
Department of Psychology, University of Bologna, Bologna, Italy.
Department of Psychology, University of Bologna, Bologna, Italy.
Compr Psychiatry. 2024 May;131:152468. doi: 10.1016/j.comppsych.2024.152468. Epub 2024 Mar 4.
Eating Disorders (ED) are characterized by low remission rates, treatment drop-out, and residual symptoms. To improve assessment and treatment of ED, the staging approach has been proposed. This systematic scoping review is aimed at mapping the existing staging models that explicitly propose stages of the progression of ED. A systematic search of PubMed, PsycINFO, Scopus was conducted with the terms staging, anorexia nervosa, bulimia nervosa, binge-eating disorders, eating disorders. Eleven studies met inclusion criteria presenting nine ED staging models, mostly for anorexia nervosa. Three were empirically tested, one of which was through an objective measure specifically developed to differentiate between stages. Most staging models featured early stages in which the exacerbation of EDs unfolds and acute phases are followed by chronic stages. Intermediate stages were not limited to acute stages, but also residual phases, remission, relapse, and recovery. The criteria for stage differentiation encompassed behavioral, psychological, cognitive, and physical features including body mass index and illness duration. One study recommended stage-oriented interventions. The current review underscores the need to empirically test the available staging models and to develop and test new proposals of staging models for other ED populations. The inclusion of criteria based on medical features and biomarkers is recommended. Staging models can potentially guide assessment and interventions in daily clinical settings.
饮食失调（ED）的特点是缓解率低、治疗中断和残留症状。为了改善饮食失调的评估和治疗，有人提出了分期方法。本系统综述旨在梳理明确提出饮食失调进展阶段的现有分期模型。通过在PubMed、PsycINFO、Scopus数据库中使用“分期”“神经性厌食症”“神经性贪食症”“暴饮暴食症”“饮食失调”等检索词进行系统检索。11项研究符合纳入标准，呈现了9种饮食失调分期模型，大多针对神经性厌食症。其中3项经过实证检验，其中1项通过专门开发的客观测量方法来区分不同阶段。大多数分期模型的早期阶段呈现饮食失调的加剧，急性期之后是慢性期。中间阶段不仅包括急性期，还包括残留期、缓解期、复发期和康复期。阶段区分标准包括行为、心理、认知和身体特征，包括体重指数和病程。有1项研究推荐了以阶段为导向的干预措施。当前综述强调有必要对现有的分期模型进行实证检验，并为其他饮食失调人群开发和检验新的分期模型提案。建议纳入基于医学特征和生物标志物的标准。分期模型有可能指导日常临床环境中的评估和干预。
