Binge Eating: Clinical Patterns & Biological Correlates

本研究的长期目标是探索通过摄入食物量来定义神经性暴食症暴食发作的效用，并揭示导致暴食症症状发展或维持的因素。另一个目标是提高对另一种症状群的认识，这种症状群类似于神经性贪食症-清除亚型，但感知到的暴食发作客观上不涉及大量食物。最近的研究表明，相当数量的年轻妇女患有这种替代症状群（主观神经性贪食症-SBN），这表明SBN是一个重大的公共卫生问题。这项研究的一个具体目的是验证这样一个假设，即与患有DSM-IV神经性贪食症的女性一样，患有SBN的女性表现出临床显著的痛苦和损害水平。第二个目的是证明SBN与DSM-IV神经性贪食症不同，因此不应在一个诊断类别中与该综合征合并。该研究提出扩展初步数据，表明患有神经性贪食症的女性比患有SBN的女性有更高的冲动水平。此外，本研究提出了一项新的研究，即与SBN女性相比，神经性贪食症女性在休息餐后是否表现出较低的饱腹感和胆囊收缩素（CCK）释放减弱。该研究将包括30名患有DSM-IV型神经性贪食症亚型的女性，30名患有SBNm的女性和30名没有饮食失调的女性。受试者将完成心理评估，包括结构化临床访谈和抑郁、焦虑、冲动、社会和职业功能的标准化问卷评估。受试者还将参与餐后饱腹感和CCK释放的评估。本研究将测试一种神经性贪食症的模型，在这种模型中，缺乏饱腹感信号不能减少进食冲动，再加上冲动控制不良，增加了客观上大量暴食发作的可能性，并揭示了神经性贪食症客观上大量暴食发作的病因或维持因素。此外，这项研究有可能确定一种新的饮食失调亚型，值得研究、治疗和纳入分类学方案。

The long term objectives of this study are to explore the utility of defining binge-eating episodes in bulimia nervosa by the amount of food consumed and to reveal factors that contribute to the development or maintenance of bulimic symptoms. An additional objective is to improve the recognition of an alternative symptom cluster that resembles bulimia nervosa-purging subtype, except that perceived binge episodes do not involve objectively large amounts of food. Recent research indicates that a substantial number of young women suffer from this alternative symptom cluster (subjective bulimia nervosa-SBN) suggesting that SBN represents a significant public health concern. One specific aim of this study is to test the hypothesis that, like women with DSM-IV bulimia nervosa, women with SBN demonstrate clinically significant levels of distress and impairment. A second aim is to demonstrate that SBN is distinct from DSM-IV bulimia nervosa and thus should not be combined with this syndrome within one diagnostic category. The study proposes to extend preliminary data suggesting that women with bulimia nervosa have higher levels of impulsiveness compared to women with SBN. In addition, this study proposes a novel examination of whether, compared to women with SBN, women with bulimia nervosa demonstrate lower levels of satiety and blunted cholecystokin (CCK) release following a rest meal. The study will include 30 women with DSM-IV bulimia nervosa-purging subtype, 30 women with SBNm and 30 non-eating disordered control females. Subjects will complete psychological assessments including structured clinical interviews and standardized questionnaire assessments of depression, anxiety, impulsiveness, and social and occupational functioning. Subjects will also participate in assessments of post-prandial satiety and CCK release. This study will test a model of bulimia nervosa in which deficient satiety signals fail to decrease the impulse to eat which, combined with poor impulse control, increases the liability to experience objectively large binge-eating episodes by the amount of food consumed and reveal etiologic or maintaining factors for objectively large bing episodes in bulimia nervosa. Further, this study has the potential to identify a new subtype of eating disorder that is worthy of study, treatment, and inclusion in nosological schemes.