Garner D M, Garner M V, Rosen L W
Eating Disorder Program, Michigan State University, East Lansing 48824.
Int J Eat Disord. 1993 Mar;13(2):171-85. doi: 10.1002/1098-108x(199303)13:2<171::aid-eat2260130205>3.0.co;2-l.
It has not been clear from earlier studies whether it is binge eating per se or the compensatory behaviors frequently associated with binge eating (i.e., self-induced vomiting and/or laxative abuse) that provide the most relevant marker for subclassifying anorexia nervosa. The current study addressed this question by comparing the clinical and psychological features of three groups of anorexia nervosa patients: "pure restricting" patients who do not binge (by definition) and who also do not purge (AN-R, N = 116); "restricting-purging" patients who engage in purging behavior (AN-RP, N = 74); and anorexia nervosa "bulimics" who binge eat as defined in earlier studies (AN-B, N = 190). While all three groups displayed similar levels of psychological disturbance on many variables, the overall pattern of findings indicates that the AN-RP group displays significantly more psychopathology than the AN-R group and their profile of disturbance is very similar to that observed with the AN-B group. Thus, anorexia nervosa patients who purge, regardless of whether or not they report objective binge episodes, may be meaningfully distinguished from nonpurging patients. These results, combined with the medical risks associated with purging behaviors and the formidable problems associated with the definition of binge eating, support a sub-typing system for anorexia nervosa based on the presence or absence of purging rather than binge eating.
早期研究尚不清楚，神经性厌食症进行亚型分类时，最具相关性的标志究竟是暴饮暴食本身，还是常与暴饮暴食相关的代偿行为（即自我催吐和/或滥用泻药）。本研究通过比较三组神经性厌食症患者的临床和心理特征来解决这一问题：“单纯限制型”患者，他们不暴饮暴食（根据定义）且不清除行为（神经性厌食症限制型，N = 116）；“限制-清除型”患者，他们有清除行为（神经性厌食症限制-清除型，N = 74）；以及如早期研究所定义的暴饮暴食的神经性厌食症“贪食型”患者（神经性厌食症贪食型，N = 190）。虽然三组在许多变量上都表现出相似程度的心理困扰，但总体研究结果表明，神经性厌食症限制-清除型组比神经性厌食症限制型组表现出明显更多的精神病理学症状，且他们的困扰特征与神经性厌食症贪食型组所观察到的非常相似。因此，有清除行为的神经性厌食症患者，无论他们是否报告有客观的暴饮暴食发作，都可能与无清除行为的患者有显著区别。这些结果，结合与清除行为相关的医学风险以及与暴饮暴食定义相关的棘手问题，支持了一种基于是否存在清除行为而非暴饮暴食的神经性厌食症亚型分类系统。
