de Zwaan M, Mitchell J E, Specker S M, Pyle R L, Mussell M P, Seim H C
Department of Psychiatry, University of Vienna, Austria.
Int J Eat Disord. 1993 Nov;14(3):289-95. doi: 10.1002/1098-108x(199311)14:3<289::aid-eat2260140307>3.0.co;2-0.
We assessed the correlation between a self-report questionnaire and an expert-rating including an initial interview and a longitudinal evaluation on the diagnosis of binge eating disorder (BED) in a sample of 100 obese women participating in a treatment program for weight reduction. The level of diagnostic agreement between patient-rating and expert-rating with regard to the presence or absence of BED was modest, with a kappa value of .57. According to Shrout, Spitzer, and Fleiss (Archives of General Psychiatry, 44, 172-177, 1987) this represents fair to good agreement beyond chance. The self-report instrument did not produce higher estimates of the frequency of BED in this selected sample of treatment seekers than the expert-rating, as observed in studies on the epidemiology of bulimia nervosa in community samples. The questionnaire identified 40 cases of BED, the expert-rating 43 cases. The results indicate that the disagreement between self-report and interview was mainly due to discordances in three of the diagnostic criteria of BED--namely loss of control, marked distress regarding binge eating, and the frequency requirement of two binge eating episodes per week for a 6-month period. Inconsistencies between subjects and clinicians with regard to the definition of an overeating episode and with regard to the behavioral indicators of loss of control did not lead to differences between self-report and observer-rating in the final diagnosis of BED.
我们评估了一份自我报告问卷与专家评级之间的相关性，专家评级包括一次初始访谈以及对100名参加减肥治疗项目的肥胖女性样本进行的暴食症（BED）诊断的纵向评估。患者评级与专家评级在BED存在与否方面的诊断一致性一般，kappa值为0.57。根据施鲁特、斯皮策和弗莱斯（《普通精神病学档案》，44卷，172 - 177页，1987年）的说法，这表明一致性达到了偶然之外的中等至良好水平。在寻求治疗者的这个选定样本中，自我报告工具对BED频率的估计并不高于专家评级，这与在社区样本中进行的神经性贪食症流行病学研究中观察到的情况相同。问卷识别出40例BED病例，专家评级识别出43例。结果表明，自我报告与访谈之间的不一致主要是由于BED的三个诊断标准存在差异，即失控、对暴饮暴食的明显困扰以及在6个月期间每周有两次暴饮暴食发作的频率要求。在暴饮暴食发作的定义以及失控行为指标方面，受试者与临床医生之间的不一致并未导致在BED最终诊断中自我报告与观察者评级之间出现差异。
