Fichter M M, Quadflieg N, Brandl B
Department of Psychiatry, University of Munich, Germany.
Int J Eat Disord. 1993 Jul;14(1):1-16. doi: 10.1002/1098-108x(199307)14:1<1::aid-eat2260140102>3.0.co;2-3.
The goal of the study was to contribute empirical data to the discussion of appropriate diagnostic classification of obese and nonobese, binging, and nonbinging eating disordered patients. The study consists of two parts: (1) patients with binge eating disorder (BED) (N = 22) are compared to a matched sample of patients with bulimia nervosa (BN) and to 16 patients with obesity (body mass index [BMI] > 30). These patient groups were cross-sectionally assessed using expert ratings (interview) and self-ratings. (2) A sample of 68 patients with BED were assessed longitudinally on admission and discharge of inpatient treatment and at a 3-year follow-up using the same instruments as in the first study. The study is the first to report longitudinal data on patients with BED. The general pattern of the cross-sectional data was that patients with BN not only had higher scores concerning disturbances of eating behavior and attitude but also for general psychopathology when compared to patients with obesity without marked binges. The scores of patients with BED had an intermediate position between BN and obesity but were closer to BN than to obesity. The BED group (and the obesity group) showed a high degree of body dissatisfaction, which, however, was accounted for by their high body weight. Concerning general psychopathology BED as well as BN had significantly higher scores than the obesity group in the Hopkin's Symptom Checklist (SCL) subscale anger and hostility, in the Complaint List, the PERI Demoralization Scale, and the Beck Depression Inventory. Results of the longitudinal study with BED showed marked improvement in specific and general psychopathology over time. Except for body weight this improvement largely persisted over the 3-year follow-up period. Severity of depression did not predict the course of body weight over time. Data are presented concerning the design of diagnostic criteria for eating disturbed patients not fitting criteria for BN or anorexia nervosa (AN). Arguments pro and contra the introduction of a new BED category in psychiatric diagnostic criteria are discussed. Although there is generally a need for developing or revising the diagnostic criteria for recurrent bingers, our data do not support inclusion of BED (as presently defined) as a separate diagnostic category in DSM-IV.
该研究的目的是为肥胖与非肥胖、有暴饮暴食行为与无暴饮暴食行为的饮食失调患者的恰当诊断分类讨论提供实证数据。该研究由两部分组成：（1）将22例神经性贪食症（BN）患者与22例匹配的神经性贪食症患者样本以及16例肥胖患者（体重指数[BMI]>30）进行比较。使用专家评定（访谈）和自评对这些患者组进行横断面评估。（2）使用与第一项研究相同的工具，对68例神经性贪食症患者样本在住院治疗入院和出院时以及3年随访时进行纵向评估。该研究首次报告了神经性贪食症患者的纵向数据。横断面数据的总体模式是，与无明显暴饮暴食行为的肥胖患者相比，神经性贪食症患者不仅在饮食行为和态度紊乱方面得分更高，而且在一般精神病理学方面得分也更高。神经性贪食症患者的得分处于神经性贪食症和肥胖之间的中间位置，但更接近神经性贪食症而非肥胖。神经性贪食症组（和肥胖组）表现出高度的身体不满意感，然而，这是由他们的高体重所致。在霍普金斯症状清单（SCL）愤怒和敌意分量表、投诉清单、PERI士气低落量表以及贝克抑郁量表中，关于一般精神病理学，神经性贪食症以及神经性贪食症患者的得分显著高于肥胖组。对神经性贪食症患者的纵向研究结果显示，随着时间推移，特定和一般精神病理学有显著改善。除体重外，这种改善在3年随访期内基本持续存在。抑郁严重程度并不能预测体重随时间的变化过程。文中给出了关于不符合神经性贪食症或神经性厌食症（AN）标准的饮食失调患者诊断标准设计的数据。讨论了在精神科诊断标准中引入新的神经性贪食症类别支持和反对的论据。虽然总体上需要制定或修订复发性暴饮暴食者的诊断标准，但我们的数据不支持将神经性贪食症（如目前所定义）作为一个单独的诊断类别纳入《精神疾病诊断与统计手册》第四版（DSM-IV）。
