Fairburn C G, Welch S L, Doll H A, Davies B A, O'Connor M E
Department of Psychiatry, Oxford University, Warneford Hospital, United Kingdom.
Arch Gen Psychiatry. 1997 Jun;54(6):509-17. doi: 10.1001/archpsyc.1997.01830180015003.
Many apparently disparate risk factors have been implicated as causes of eating disorders. This study was designed to test the hypothesis that 2 broad classes of risk factors exist for bulimia nervosa: those that increase the risk for development of a psychiatric disorder in general and those that increase the risk of dieting. It was predicted that the latter are especially common among persons with bulimia nervosa.
A case-control design was used involving 2 integrated comparisons. First, 102 subjects with bulimia nervosa were compared with 204 healthy control subjects without an eating disorder. Second, the same 102 subjects with bulimia nervosa were compared with 102 subjects with other psychiatric disorders. To reduce sampling bias, the subjects were recruited directly from the community. A broad range of putative risk factors was assessed.
The subjects with bulimia nervosa and the healthy control subjects differed in their rates of exposure to most of the putative risk factors. Far fewer differences were evident between the subjects with bulimia nervosa and the control subjects with other psychiatric disorders, although exposure to factors that were likely to increase the risk of dieting and to negative self-evaluation and certain parental problems (including alcohol use disorder) were substantially more common among those with bulimia nervosa.
The findings support the hypothesis that bulimia nervosa is the result of exposure to general risk factors for psychiatric disorder and risk factors for dieting. An unexpected finding was the particularly high rates of premorbid negative self-evaluation and certain parental problems among those with bulimia nervosa.
许多看似不同的风险因素都被认为是饮食失调的原因。本研究旨在检验以下假设：神经性贪食症存在两类广泛的风险因素，一类是总体上增加精神疾病发病风险的因素，另一类是增加节食风险的因素。预计后者在神经性贪食症患者中尤为常见。
采用病例对照设计，涉及两项综合比较。首先，将102名神经性贪食症患者与204名无饮食失调的健康对照者进行比较。其次，将同样的102名神经性贪食症患者与102名患有其他精神疾病的患者进行比较。为减少抽样偏差，直接从社区招募受试者。评估了广泛的假定风险因素。
神经性贪食症患者与健康对照者在大多数假定风险因素的暴露率上存在差异。神经性贪食症患者与患有其他精神疾病的对照者之间的差异明显较少，尽管在神经性贪食症患者中，接触可能增加节食风险、消极自我评价以及某些父母问题（包括酒精使用障碍）的因素更为常见。
研究结果支持以下假设，即神经性贪食症是接触精神疾病的一般风险因素和节食风险因素的结果。一个意外发现是，神经性贪食症患者病前消极自我评价和某些父母问题的发生率特别高。
