Billman Miller Marley G, Abber Sophie R, Hamilton Antonia, Ortiz Shelby N, Jacobucci Ross C, Essayli Jamal H, Smith April R, Forrest Lauren N
Department of Psychological Sciences, Auburn University.
Department of Psychology, Florida State University.
J Psychopathol Clin Sci. 2025 Feb;134(2):162-172. doi: 10.1037/abn0000962. Epub 2024 Dec 16.
The fifth edition of defines anorexia nervosa (AN) severity based on body mass index (BMI). However, BMI categories do not reliably differentiate the intensity of AN and comorbid symptoms. Shape/weight overvaluation has been proposed as an alternative severity specifier. The present study used structural equation model (SEM) Trees to empirically determine specific levels of BMI and/or shape/weight overvaluation that differentiate AN severity. We also compared whether the SEM Tree-derived severity groups outperformed existing AN severity definitions. Participants were 1,666 adolescents and adults with AN who were receiving eating disorder treatment at one of the three levels of care (outpatient, partial hospital program, or residential). Participants completed self-reported questionnaires assessing eating pathology and comorbid symptoms. SEM Tree analyses first specified an outcome model of AN severity, and then recursively partitioned the outcome model into subgroups based on all values of BMI and shape/weight overvaluation. One-way analyses of variance and t tests determined which severity definition explained the most variance in clinical characteristics. SEM Tree analyses yielded five severity groups, all of which were defined based on increasing intensities of shape/weight overvaluation: < 2.25, 2.25-3.24, 3.25-4.24, 4.25-5.24, and ≥ 5.25. No groups were defined based on BMI. SEM Tree-derived groupings explained more variance in clinical characteristics than existing severity definitions. Taken together, shape/weight overvaluation appears to be a more accurate marker of AN severity than BMI. The empirically determined AN severity scheme accounted for the most variance in clinical characteristics. Future research should assess the predictive value of these empirically defined AN severity indicators. (PsycInfo Database Record (c) 2025 APA, all rights reserved).
《》第五版根据体重指数(BMI)定义神经性厌食症(AN)的严重程度。然而,BMI类别并不能可靠地区分AN及共病症状的强度。形状/体重高估已被提议作为一种替代的严重程度说明符。本研究使用结构方程模型(SEM)树来实证确定区分AN严重程度的BMI和/或形状/体重高估的特定水平。我们还比较了SEM树得出的严重程度分组是否优于现有的AN严重程度定义。参与者为1666名患有AN的青少年和成年人,他们正在三级护理(门诊、部分住院项目或住院治疗)中的一级接受饮食失调治疗。参与者完成了评估饮食病理学和共病症状的自我报告问卷。SEM树分析首先指定了一个AN严重程度的结果模型,然后根据BMI和形状/体重高估的所有值将结果模型递归划分为子组。单因素方差分析和t检验确定了哪种严重程度定义能解释临床特征中最大的方差。SEM树分析产生了五个严重程度组,所有组均根据形状/体重高估强度的增加来定义:<2.25、2.25 - 3.24、3.25 - 4.24、4.25 - 5.24和≥5.25。没有根据BMI定义组。与现有的严重程度定义相比,SEM树得出的分组能解释临床特征中更多的方差。总体而言,形状/体重高估似乎是比BMI更准确的AN严重程度标志物。实证确定的AN严重程度方案在临床特征中解释的方差最大。未来的研究应评估这些实证定义的AN严重程度指标的预测价值。(PsycInfo数据库记录(c)2025美国心理学会,保留所有权利)