武汉地区大一女生神经性厌食症的初步调查

目的 调查武汉地区大一女生的体重和体重指数以及异常进食行为,了解武汉地区大一女生摄食障碍和神经性厌食症(非肥胖恐惧型)的发生率.方法 以2009年9月份入学的大一女生8 520人为抽样研究对象,根据摄食障碍问卷(EDI)筛选出可疑摄食障碍学生589名,然后用EDE和SCID量表对这些学生进行访谈诊断,75名学生被诊断为摄食障碍.结果 (1)武汉地区大一女生的理想体重普遍比实际体重低,理想体重指数与实际体重指数之间差异有统计学意义;(2)摄食障碍的发生率为8.803‰,其中AN 0.352‰、BN 1.174‰、EDNOS(包括BED) 7.277‰,EDNOS是摄食障碍类型中最普遍的一个类别;(3)没有发现AN(非肥胖恐惧型)患者;(4)摄食障碍组与非摄食障碍组被试在EDI量表的求瘦倾向、内省、贪食、躯体不满、无效感以及成熟恐惧分量表上的得分都要高,且差异有统计学意义.结论 女大学生是摄食障碍的高危群体,需给予重视.肥胖恐惧依然是摄食障碍的核心表现.     

喂食及进食障碍的核心特征与治疗

喂食及进食障碍的代表疾病主要包括神经性厌食、神经性贪食、暴食障碍等,该组障碍的共同特征是进食或与进食相关行为的持续性紊乱。神经性厌食的核心特征是持续限制能量摄取,强烈害怕体重增加,对自我体重的感知紊乱。神经性贪食的核心特征是反复发作的暴食,因为对体重的不恰当认知而出现的反复性不健康的代偿行为。暴食障碍的核心特征是短期内大量进食,难以控制。喂食及进食障碍的治疗目标是帮助患者恢复正常的体重,通过认知行为疗法(CBT)、家庭治疗或团体治疗帮助个体调整对体型、体重和美的认知,也可给予抗抑郁药物、小剂量抗精神分裂药物或心境稳定剂进行对症治疗。     

暴食性障碍

读者来信编辑先生 :CCMD- 2 - R神经性贪食症诊断标准中的第 3条是 :常采取引吐、导泻、禁食或过度锻炼等代偿方法 ,以消除暴食引起的发胖。可是 ,有些病人虽有贪食 ,但没有这些代偿方法 ,还可不可以诊断为神经性贪食症 ?扬州市　杨华答读者来信杨华医师 :如果病人有发作性不可控制的贪食 ,但无呕吐 ,滥用轻泻剂、禁食或过度锻炼这些代偿方法 ,则不应诊断为神经性贪食症 ( bulimia nervosa) ,而应诊断为暴食性障碍 ( binge- eating disorders)。该障碍是新认识到的疾病 ,在 CCMD- 2 - R中尚无具体描述 ,而在 DSM- 中也只有研究标准 ,…     

神经性贪食患者的冲动性特质综述

神经性贪食(BN)是以反复发作不可控制的大量进食、清除或代偿行为为主要特征的一类进食障碍;冲动性特质可能参与BN的病理机制。本文从人格特质、行为学特征、神经生物学、神经递质等方面对BN患者的冲动性特质进行综述。     

1例中国被收养女性罹患神经性贪食症的案例:跨文化研究

概述:一直以来,饮食障碍被认为是西方国家特有的与文化相关的综合症.因为神经性厌食症,这个理论似乎己被打破,但仍少有关于神经性贪食症的跨文化研究,故这方面文献有限.在本临床病例中,我们试图探讨文化因素对这一疾病的影响.我们研究了此病例中的非典型特征,特别关注到容易被忽略的患者的外表容貌和收养隐秘被揭晓所诱发的心理冲击.神经性贪食症触发了一种亲子关系和自我认同的重新寻找,以期日后再度恢复良好家庭关系并最终获得自我.同样我们也研究本病例中的中国收养状况.本病例提示文化因素影响的重要性,跨文化研究可以帮助我们更好的理解神经性贪食症,并提示了有效治疗手段.     

神经性厌食中贪食症的起病形式

过去几年里,对神经性厌食(简称厌食症)与贪食症间的病因关系倍加关注。以往     

进食障碍基于家庭的治疗北大核心CSCD

进食障碍(eating disorders,ED)主要指以反常的进食行为和心理紊乱为特征,并伴发显著体重改变和(或)生理功能紊乱的一组慢性难治性精神障碍[1]。其主要包括神经性厌食症(anorexia nervosa,AN)、神经性贪食症(bulimia nervosa,BN)和暴食障碍(binge eating disorders,BED)[2]。进食障碍好发于青少年和年轻女性[1-2],其中AN的发病年龄在13~20岁,发病的高峰年龄在13~14岁和17~18岁;BN的发病年龄在12~35岁,平均为18岁。该病呈现高病死率、高共病率、高疾病负担[3],且有证据显示我国近年来进食障碍患者数量有增多的趋势[4],因此寻求循证有效的进食障碍治疗方法是当务之急。     

104例进食障碍患者临床特征分析

目的:了解住院进食障碍患者的临床特征. 方法:将符合国际疾病分类第10版(ICD-10)神经性厌食症(AN)和神经性贪食症(BN)诊断标准的104例住院进食障碍患者按不同临床类型分组,对两组患者心理、生理、社会三方面的临床特征进行回顾性比较. 结果:AN和BN患者的怕胖心理、闭经、误工误学时间及减少食物对身体影响的方式等临床特点差异无显著性(P>0.05).但是AN患者较BN患者发病年龄早,体象障碍比较多见(P均<0.01,或P均<0.05).BN患者比AN患者有更多抑郁症状,病程较长,就诊年龄晚(P<0.01). 结论:进食障碍两大综合征可能是一个疾病进程中的两个不同阶段,而贪食症的危害更应引起重视.     

1例中国被收养女性罹患神经性贪食症的案例:跨文化研究（英文）

概述:一直以来,饮食障碍被认为是西方国家特有的与文化相关的综合症。因为神经性厌食症,这个理论似乎已被打破,但仍少有关于神经性贪食症的跨文化研究,故这方面文献有限。在本临床病例中,我们试图探讨文化因素对这一疾病的影响。我们研究了此病例中的非典型特征,特别关注到容易被忽略的患者的外表容貌和收养隐秘被揭晓所诱发的心理冲击。神经性贪食症触发了一种亲子关系和自我认同的重新寻找,以期日后再度恢复良好家庭关系并最终获得自我。同样我们也研究本病例中的中国收养状况。本病例提示文化因素影响的重要性,跨文化研究可以帮助我们更好的理解神经性贪食症,并提示了有效治疗手段。     

回避性/限制性摄食障碍一例

回避性/限制性摄食障碍（avoidant/restrictive food intake disorder,ARFID）是DSM-5中摄食障碍疾病,常发生于青少年儿童,也可成年起病,常表现为具有临床意义的对某些食物或食物类别摄取的回避或限制,极大影响患者身心健康。国内对于该疾病临床经验较少,国外采用营养支持、认知行为治...     

Eating disorder not otherwise specified in adolescents

OBJECTIVE: To examine the frequency, type, and clinical severity of eating disorder not otherwise specified (EDNOS) in adolescents seeking treatment through an outpatient eating disorders service. METHOD: Two hundred eighty-one consecutive referrals to an eating disorders program were assessed using the Eating Disorder Examination (EDE) and self-report measures of depression and self-esteem. RESULTS: The majority of adolescents presented with EDNOS (59.1%; n = 166) relative to anorexia nervosa (AN; 20.3%; n = 57) and bulimia nervosa (BN; 20.6%; n = 58). Most EDNOS youths could be described as subthreshold AN (SAN; 27.7%; n = 46), subthreshold BN (SBN; 19.9%; n = 33), EDNOS purging (27.7%; n = 46), or EDNOS bingeing (6.0%; n = 10); yet 31 (18.7%) could not be categorized as such (EDNOS "other"). Overall differences in eating disorder pathology, depressive symptoms, and self-esteem emerged between the EDNOS types, wherein adolescents with EDNOS bulimic variants (SBN, EDNOS purging, and EDNOS bingeing) had more pathology than youths with SAN or EDNOS "other." There were no differences in these variables between AN and SAN; in contrast, compared with BN, youths with EDNOS bulimic variants reported lower EDE scores and higher self-esteem, although there were no between-group differences in depression. CONCLUSIONS: As in adults with eating disorders, EDNOS predominates and is heterogeneous with regard to eating disorder pathology and associated features in an adolescent clinical sample. Lack of differences between AN and SAN suggests that the strict criteria for AN could be relaxed; differences between BN and EDNOS bulimic variants do not support their combination.     

Full-syndrome,partial-syndrome and subclinical eating disorders: an epidemiological study of female students in Southern Italy

We screened a sample of 919 female students, aged 13–19 years, by means of the EDI 2 and GHQ-28 questionnaires. Those students identified as being at risk for an eating disorder (281 subjects) underwent a psychiatric interview. We found 2 cases of full-syndrome anorexia nervosa (0.2%), 21 cases of full-syndrome bulimia nervosa (2.3%) and 2 cases of full-syndrome binge-eating disorder (0.2%). Moreover, 35 girls (3.8%) met the criteria for partial-syndrome and 98 girls (10.7%) fulfilled the criteria for subclinical eating disorders. Subjects with partial-syndrome and subclinical eating disorders had higher scores than those with no diagnosis, but lower scores than students with full-syndrome eating disorders, on both the EDI 2 and GHQ-28 questionnaires. A follow-up of subjects with partial-syndrome and subclinical eating disorders is now in progress.     

The incidence of eating disorders in a Danish register study: Associations with suicide risk and mortality

Our aim was to characterize the incidence rates and cumulative incidence of anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder not otherwise specified (EDNOS), and examine associations among eating disorder diagnoses, suicide attempts, and mortality. Individuals born in Denmark between 1989 and 2006 were included (N = 966,141, 51.3% male). Eating disorders diagnoses (AN, broad AN, BN, EDNOS) were drawn from the Danish Psychiatric Central Research Register (PCRR) and Danish National Patient Register (NPR). Suicide attempts and deaths were captured in the NPR, the PCRR, and the Danish Civil Registration System (CRS). In females, AN had a peak hazard at approximately age 15 years, BN at 22 years, and EDNOS had an extended peak that spanned 18 years–22 years. Eating disorder diagnoses predicted a significantly higher hazard for death and suicide attempt compared with the referent of individuals with no eating disorders. In males, peak hazard for diagnosis was earlier than in females. The present study represents one of the largest and longest studies of eating disorder incidence and suicide attempts and death in both females and males. Eating disorders are accompanied by increased hazard of suicide attempts and death even in young adults.     

The association between interpersonal problems and treatment outcome in the eating disorders: A systematic review

Abstract

Objective: To review systematically the eating disorder literature in order to examine the association between pre-treatment interpersonal problems and treatment outcome in people diagnosed with an eating disorder. Methods: Six relevant databases were searched for studies in which interpersonal problems prior to treatment were examined in relation to treatment outcome in patients diagnosed with anorexia nervosa (AN), bulimia nervosa (BN) or eating disorders not otherwise specified (EDNOS). Results: Thirteen studies were identified (containing 764 AN, 707 BN and 48 EDNOS). The majority of studies indicated that interpersonal problems at the start of therapy were associated with a detrimental treatment outcome. Conclusions: Individuals with a binge/purge-type of eating disorder may be particularly vulnerable to interpersonal issues and these issues may lead to poorer treatment recovery by reducing the individual's ability to engage in the treatment process on a functional level. The clinical and research implications are discussed.     

Health-related quality of life among adolescents with eating disorders

Objective

Health-related quality of life (HRQoL) is an emerging area of research in eating disorders (EDs) that has not been examined in adolescents in detail. The aim of the current study is to investigate HRQoL in an adolescent ED sample, examining the impact of ED symptoms on HRQoL.

Methods

Sixty-seven treatment-seeking adolescents (57 females) with anorexia nervosa (AN), bulimia nervosa (BN), or eating disorder not otherwise specified (EDNOS) completed self-report measures of HRQoL and ED symptoms.

Results

Participants reported poorer HRQoL in mental health domains than in physical health domains. Disordered attitudes, binge eating, and compensatory behaviors were associated with poorer mental health HRQoL, and body dissatisfaction was associated with poorer physical health HRQoL.

Conclusion

The current study assessed HRQoL among adolescents with EDs, finding several consistencies with the literature on adults with EDs. Future research should compare adolescents and adults with EDs on HRQoL.     

Parent and child report of family functioning in a clinical child and adolescent eating disorders sample

OBJECTIVE: To investigate parent and self-report of family dysfunction in children and adolescents with eating disorders. Further, to investigate family functioning differences across the eating disorders diagnostic groups; anorexia nervosa, eating disorders not otherwise specified (EDNOS) and bulimia nervosa, and between the restricting and binge-purge eating disorders behavioural subtypes. METHODS: The Family Adjustment Device General Functioning Scale (FAD-GFS) was administered to 100 children and their parents who presented consecutively at an eating disorders assessment clinic. DSM-IV eating disorders diagnoses in this group included 42 children diagnosed with anorexia nervosa, 26 with EDNOS, 12 with bulimia nervosa and 20 diagnosed as having no eating disorder. RESULTS: Both the parent and child FAD-GFS report demonstrated high internal consistency supporting the suitability of this instrument for research with this sample. Parent and child reports were moderately positively correlated. Total scores for all eating disorders diagnostic categories were significantly higher than community norms. Anorexia nervosa, EDNOS and bulimia nervosa groups did not significantly differ on parent or child reports. FAD-GFS profiles for restricters and binge-purgers suggest higher levels of family dysfunction in the families of binge purgers. CONCLUSIONS: The FAD-GFS has suitable psychometric properties for use as a summary instrument with young people diagnosed with an eating disorder. However, more informative instruments assaying a greater range of constructs, especially in the impulsive, dyscontrol domain, are required to investigate differences among eating disorders diagnostic groups and behavioural subtypes.     

Quality of life in eating disorders: A meta-analysis

Eating disorders (EDs) comprise a variety of symptoms and have a profound impact on everyday life. They are associated with high morbidity and mortality. The objective of this study was to analyse published data on health-related quality of life (HRQoL) in EDs so as to compare the results to general population norm data and to investigate potential differences between ED diagnostic groups. A systematic review of the current literature was conducted using a keyword-based search in PubMed and PsychInfo. The search covered anorexia nervosa (AN), bulimia nervosa (BN), eating disorders not otherwise specified (EDNOS) and binge eating disorder (BED) and used the Medical Outcomes Study Short Form-36 Health Survey (SF-36) as a measure of HRQoL. Of the 102 citations identified, 85 abstracts were reviewed and seven studies were included in the meta-analysis. AN patients were included in five studies (n=227), BN in four studies (n=216), EDNOS in two studies (n=166) and BED in four studies (n=148). We tested for between-study variation and significant differences between the diagnostic groups. The results confirmed a significantly lower level of HRQoL in all EDs compared to a population mean. It was not possible to establish any differences between the diagnostic groups.     

Prevalence and long-term course of lifetime eating disorders in an adult Australian twin cohort

OBJECTIVE: Few studies exist that have examined the spectrum and natural long-term course of eating disturbance in the community. We examine the lifetime prevalence and long-term course of anorexia nervosa (AN), bulimia nervosa (BN) and eating disorder not otherwise specified (EDNOS) in an adult female twin population. METHOD: Female twins (n = 1002) from the Australian Twin Registry, aged 28-39 years, were assessed using the Eating Disorder Examination, revised to yield lifetime diagnostic information. For women with lifetime eating disorders, the assessment occurred, on average, 14.52 years (SD = 5.65) after onset of their disorder. RESULTS: In accordance with other community studies, we found a 1.9% lifetime prevalence of AN, with an additional 2.4% who met the criteria for 'partial AN' (absence of amenorrhea). Criteria for BN were met by 2.9% of the women, an additional 2.9% of women met criteria for binge eating disorder, while 5.3% met criteria for purging disorder unaccompanied by binge eating (EDNOS-p). Eleven (7%) of the women with lifetime eating disorders had a current eating disorder. Each diagnostic group continued to be differentiated by current eating pathology from women without lifetime eating disorders. Although approximately 75% of the women had a good outcome, less than 50% of each diagnostic group was asymptomatic. CONCLUSIONS: Eating disorders tend to improve over time often reaching subdiagnostic levels of severity, but only a minority of sufferers becomes asymptomatic. The DSM-IV diagnosis EDNOS needs to be considered in studies of the prevalence and course of eating disorders.     

Prevalence of eating disorders among adolescent and young adult scholastic population in the region of Madrid (Spain)

OBJECTIVE: The prevalence of eating disorders (EDs) in a representative scholastic sample was evaluated, and the demographic factors associated with ED were assessed. METHOD: The study used a two-stage epidemiological design. The study population was a randomly selected sample of 1545 students (12- to 21-year-old males and females) in the region of Madrid (Spain). RESULTS: ED prevalence was 3.43%. Prevalence estimations were as follows: 5.34% for females: 2.72% for eating disorders not otherwise specified (EDNOS), 2.29% for bulimia nervosa (BN), and 0.33% for anorexia nervosa (AN); and 0.64% for males: 0.48% for EDNOS, 0.16% for BN, and 0.00% for AN. Some demographic factors that were shown to be associated with ED included the following: sex, age, single child, single-parent families, and father or mother's death. DISCUSSION: Despite the methodological improvements over previous epidemiological studies developed in Spain, there were no significant differences in the prevalence estimations.