Specker S, de Zwaan M, Raymond N, Mitchell J
Department of Psychiatry, University of Minnesota Medical School, Minneapolis.
Compr Psychiatry. 1994 May-Jun;35(3):185-90. doi: 10.1016/0010-440x(94)90190-2.
The examination of psychopathology in subgroups of obese patients is a new area of research in psychiatry. This project studied rates and types of psychopathology among obese subjects meeting the proposed DSM-IV criteria of binge eating disorder (BED) and obese subjects without BED. One hundred obese women with a mean age of 39.2 years and a mean body mass index (BMI) of 35.9 kg/m2 were evaluated using the Structured Clinical Interview for DSM-III-R (SCID-Modified Version) and a self-rating personality inventory, Personality Diagnostic Questionnaire-Revised (PDQ-R), before entering a treatment study for weight reduction. Those subjects meeting proposed DSM-IV criteria for BED had significantly higher lifetime rates for an axis I diagnosis compared with those that did not meet criteria for BED. Subjects with BED showed higher rates of lifetime affective disorder and bulimia nervosa, but did not differ on any other axis I diagnoses. Axis II cluster B and cluster C diagnoses were found more frequently among BED subjects. The specific diagnoses of histrionic, borderline, and avoidant personality disorders were found significantly more often among BED subjects. The results support the idea that binge eating may identify a distinct subgroup among the obese population who have significantly higher rates of certain forms of psychopathology on both Axis I and Axis II. The findings of increased rates of depression are consistent with other studies and suggest that our treatment modalities need to address this problem.
对肥胖患者亚组的精神病理学检查是精神病学研究的一个新领域。该项目研究了符合拟议的《精神疾病诊断与统计手册》第四版（DSM-IV）暴饮暴食症（BED）标准的肥胖受试者和无BED的肥胖受试者中精神病理学的发生率及类型。在进入一项减肥治疗研究之前，使用针对DSM-III-R的结构化临床访谈（SCID-修订版）和一份自评人格量表——《人格诊断问卷-修订版》（PDQ-R），对100名平均年龄为39.2岁、平均体重指数（BMI）为35.9kg/m²的肥胖女性进行了评估。与不符合BED标准的受试者相比，那些符合拟议的DSM-IV BED标准的受试者在I轴诊断上的终生发生率显著更高。患有BED的受试者在终生情感障碍和神经性贪食症方面的发生率更高，但在其他任何I轴诊断上并无差异。在患有BED的受试者中，II轴B类和C类诊断更为常见。表演型、边缘型和回避型人格障碍的具体诊断在患有BED的受试者中显著更为常见。这些结果支持了这样一种观点，即暴饮暴食可能在肥胖人群中识别出一个独特的亚组，他们在I轴和II轴上某些形式的精神病理学发生率显著更高。抑郁症发生率增加的研究结果与其他研究一致，并表明我们的治疗方式需要解决这个问题。
