Schaefer Lauren M, Forester Glen, Dougherty Elizabeth N, Bottera Angeline R, Forbes Erika E, Wildes Jennifer E
Center for Biobehavioral Research, Sanford Research, Sioux Falls, ND, USA.
Department of Psychiatry, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA.
J Eat Disord. 2024 Dec 24;12(1):212. doi: 10.1186/s40337-024-01169-8.
Accruing evidence suggests that personality-based approaches to eating disorder classification may offer several advantages over current diagnostic models, with prior research consistently identifying three personality-based groups characterized by either (1) high levels of impulsivity and dysregulation (termed the "undercontrolled" group), (2) high levels of rigidity and avoidance (termed the "overcontrolled" group), or (3) relatively normative levels of personality functioning (termed the "low psychopathology" group). Cognitive inflexibility (i.e., difficulty adjusting thoughts or behaviors) has theorized relevance to eating disorders. However, prior research has frequently failed to observe differences in cognitive inflexibility across eating disorder diagnostic groups. The present study aimed to identify personality-based groups in an eating disorder sample, and then to examine the relations between these groups and behavioral measures of cognitive inflexibility.
83 men and women who met DSM-5 criteria for anorexia nervosa or bulimia nervosa completed self-report questionnaires to assess trait-level approach/avoidance behaviors and impulsivity, as well as behavioral tasks assessing attentional set-shifting and reversal learning, two facets of cognitive inflexibility.
Latent profile analysis of measures assessing approach/avoidance behaviors and impulsivity supported a three-class model replicating the undercontrolled, overcontrolled, and low psychopathology groups. Notably, the low psychopathology group was characterized by elevated reward responding. One-way ANOVAs indicated that the low psychopathology group demonstrated heightened perseverative errors (an indicator of impaired reversal learning) relative to the other groups. No group differences were observed for attentional set-shifting errors or probabilistic switch errors.
Findings from the present study provide additional support for personality-based classification approaches identifying undercontrolled, overcontrolled, and low psychopathology eating disorder groups. Results also suggest that reward-related processes may contribute to disorder maintenance in the low psychopathology group, indicating potentially meaningful targets for intervention.
越来越多的证据表明，基于人格的饮食失调分类方法可能比当前的诊断模型具有若干优势，先前的研究一直确定了三类基于人格的群体，其特征分别为：（1）高度冲动和失调（称为“控制不足”组）；（2）高度僵化和回避（称为“控制过度”组）；或（3）相对正常水平的人格功能（称为“低精神病理学”组）。认知灵活性不足（即难以调整思维或行为）在理论上与饮食失调有关。然而，先前的研究经常未能观察到饮食失调诊断组之间在认知灵活性不足方面的差异。本研究旨在确定饮食失调样本中基于人格的群体，然后检验这些群体与认知灵活性不足的行为测量之间的关系。
83名符合《精神疾病诊断与统计手册》第5版神经性厌食症或神经性贪食症标准的男性和女性完成了自我报告问卷，以评估特质水平的趋近/回避行为和冲动性，以及评估注意力转换和逆向学习（认知灵活性不足的两个方面）的行为任务。
对评估趋近/回避行为和冲动性的测量进行潜在剖面分析，支持了一个三类模型，该模型复制了控制不足、控制过度和低精神病理学组。值得注意的是，低精神病理学组的特征是奖励反应增强。单因素方差分析表明，与其他组相比，低精神病理学组表现出更多的持续性错误（逆向学习受损的一个指标）。在注意力转换错误或概率转换错误方面未观察到组间差异。
本研究结果为基于人格的分类方法提供了额外支持，该方法可识别控制不足、控制过度和低精神病理学的饮食失调群体。结果还表明，与奖励相关的过程可能导致低精神病理学组的疾病维持，这表明了潜在有意义的干预目标。
