Geist R, Davis R, Heinmaa M
Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario.
Can J Psychiatry. 1998 Jun;43(5):507-12. doi: 10.1177/070674379804300510.
To identify the diagnostic subtypes of eating disorders (EDs), the psychiatric comorbid diagnoses, and associated specific and nonspecific psychopathology in a series of 120 adolescents undergoing standardized assessment for an ED.
Consecutive patients referred to our large pediatric hospital for ED assessment completed a semistructured diagnostic interview for children and adolescents. The following self-report scales were administered to assess specific and nonspecific psychopathology: the Children's Depression Inventory (CDI), the Brief Symptom Inventory (BSI), the Eating Disorder Inventory 2 (EDI-2), and the Family Assessment Measure (FAM-III) of family functioning.
Female subjects with a mean age of 14.5 years and a mean body mass index (BMI) of 18.1 comprised 93% of the sample. The restrictive subtypes of anorexia nervosa (AN) (43%) and eating disorder not otherwise specified (EDNOS) (16%) were the most common diagnoses. Patients with restricting symptoms (R) could be grouped together because they were more similar to each other with respect to self-report symptoms of psychopathology than they were to patients with binge/purge (B/P) symptoms and vice versa. Patients with R endorsed significantly fewer subjective symptoms, both ED-specific and nonspecific, and rated their families functioning better than did B/P patients. Comorbid, current major depressive disorders and dysthymic disorders occurred in 66% of subjects, but depressive, dysthymic, and oppositional disorders occurred in 96% of those with B/P symptoms. Severity of the CDI was the best single discriminator between R and B/P subjects.
Adolescents with EDs in the early stage of their illness are similar to adults with EDs in the following ways: they meet the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for subtypes of EDs (excluding amenorrhea) and commonly have comorbid psychiatric disorders, especially depressive disorders. Patients with B/P symptoms can be distinguished from restricting subjects because they endorse significantly more ED-specific and nonspecific psychopathology and have a higher frequency of comorbid Axis I diagnoses (especially depressive disorders) than restricting patients. Oppositional defiant disorder (ODD) occurs more commonly in adolescents with EDs associated with B/P symptoms.
在120名接受饮食失调（ED）标准化评估的青少年中，确定饮食失调的诊断亚型、精神共病诊断以及相关的特定和非特定精神病理学特征。
连续转诊至我们大型儿科医院进行ED评估的患者完成了一份针对儿童和青少年的半结构化诊断访谈。使用以下自我报告量表来评估特定和非特定精神病理学特征：儿童抑郁量表（CDI）、简明症状量表（BSI）、饮食失调量表2（EDI - 2）以及家庭功能评估量表（FAM - III）。
样本中93%为平均年龄14.5岁、平均体重指数（BMI）为18.1的女性受试者。神经性厌食症（AN）的限制型亚型（43%）和未特定的饮食失调（EDNOS）（16%）是最常见的诊断。有节食症状（R）的患者可以归为一组，因为相较于有暴饮暴食/清除症状（B/P）的患者，他们在精神病理学自我报告症状方面彼此更为相似，反之亦然。有R症状的患者认可的特定和非特定主观症状明显更少，且对家庭功能的评价比B/P患者更好。66%的受试者存在共病的当前重度抑郁症和心境恶劣障碍，但96%有B/P症状的患者存在抑郁、心境恶劣和对立违抗障碍。CDI的严重程度是区分R和B/P受试者的最佳单一指标。
处于疾病早期的青少年饮食失调患者在以下方面与成年饮食失调患者相似：他们符合《精神疾病诊断与统计手册》（DSM - IV）中饮食失调亚型的标准（不包括闭经），且通常患有共病精神障碍，尤其是抑郁症。有B/P症状的患者与节食患者不同，因为他们认可的特定和非特定精神病理学特征明显更多，且共病轴I诊断（尤其是抑郁症）的频率高于节食患者。对立违抗障碍（ODD）在与B/P症状相关的青少年饮食失调患者中更为常见。
