Empirical eating disorder classification and validation using prospective studies

描述(由申请人提供)：相当数量的青少年和年轻人患有饮食失调，其中许多会导致严重的健康问题。因此，创建一个有效的分类方案是非常重要的，因为它是帮助指导治疗和预防计划所必需的。在美国和英国的青少年和年轻成年女性中，大约0.1-1%患有神经性厌食症，1-3%患有神经性暴食症。尽管《精神疾病诊断和统计手册-IV》(DSM-IV)标准被广泛用于对个人进行分类，但饮食障碍的诊断并没有得到经验上的定义，大多数饮食障碍个人不符合神经性厌食症或神经性暴食症的标准。此外，诊断标准可能不会涵盖所有早发病例，也不清楚它们是否适合用于男性。我们建议从两项正在进行的队列研究中收集更多关于进食障碍和治疗的数据，这两项研究是美国的今日成长研究(GUTS)和英国的雅芳亲子纵向研究(ALSPAC)，以经验性地创建进食障碍分类方案。我们将使用潜在类别分析，并将得到的分类与现有的DSM-IV分类以及在两项横断面研究中通过潜在类别分析提出的另一种分类进行比较。我们将使用自1996年以来每12-24个月跟踪一次的16,882名肠道参与者的数据，利用潜在类别分析经验地推导出饮食障碍分类方案。我们将确定进食障碍症状的最佳分组，以及最佳截止点(例如，每周暴饮暴食一次，而不是每周两次)。我们将使用青春期和青壮年期间的共病和结局(体重增加和体重状况、共病抑郁、焦虑、药物和酒精使用以及症状的持续或恶化)作为验证者。通过收集有关治疗历史的信息，我们可以评估这些模式和相关性是否因性别、年龄或肠道队列中的治疗历史而异。我们将使用在ALSPAC中14岁、16岁和18岁收集的相同的饮食紊乱信息来测试在肠道中观察到的结果是否可以复制，因此是可推广的。我们建议使用两项最大的前瞻性研究，对青春期和成年期的饮食失调进行频繁评估，以经验地得出分类方案，并将其与已经频繁使用的系统(DSM-IV)进行比较，但已知该系统对许多人不起作用，以及已提出的替代分类系统。我们样本的大小和重复评估不仅使我们能够从经验上确定最佳的症状分组，而且还允许我们提出暴饮暴食和排泄的有效频率界限。

DESCRIPTION (provided by applicant): A non-trivial number of adolescents and young adults suffer from an eating disorder, many of which lead to serious health problems. Therefore, creating a validated classification scheme is of major importance, as it is needed to help guide treatment and prevention programs. Among adolescent and young adult women in the United States and the United Kingdom, approximately 0.1-1% have anorexia nervosa and 1-3% have bulimia nervosa. Although the Diagnostic and Statistical Manual for Mental Disorders-IV (DSM-IV) criteria are widely used to classify individuals, the eating disorder diagnoses were not empirically defined and the majority of eating disordered individuals do not meet the criteria for anorexia nervosa or bulimia nervosa. Moreover, the diagnostic criteria may not capture all early onset cases and it is unclear whether they are appropriate to use with males. We propose to collect additional data on eating disorders and treatment from two ongoing cohort studies, the Growing Up Today Study (GUTS) in the United States and the Avon Longitudinal Study of Parents and Children (ALSPAC) in the United Kingdom to empirically create an eating disorder classification scheme. We will use latent class analysis and compare the resulting classification to the existing DSM-IV classification, as well as another classification proposed from latent class analyses in two cross-sectional studies. We will use data from the 16,882 participants in GUTS who have been followed every 12-24 months since 1996 to empirically derive an eating disorder classification scheme using latent class analysis. We will determine the best groupings of eating disorder symptoms, as well as the best cut-offs (such as engaging in binge eating > once per week vs. > two times per week). We will use comorbidity and outcome (weight gain and weight status, comorbid depression, anxiety, substance and alcohol use, and persistence or worsening of symptoms) during adolescence and young adulthood as the validators. By collecting information on treatment history we can assess whether these patterns and associations vary by gender, age, or treatment history in the GUTS cohort. We will use the same eating disorder information collected at ages 14, 16, and 18 years in ALSPAC to test whether the observed results in GUTS can be replicated and are therefore generalizable. We propose to use the two largest prospective studies with frequent assessments of disordered eating during adolescence and young adulthood to empirically derive a classification scheme and compare it to the system that is already frequently used (DSM-IV), but is known to not work well for many individuals, as well as an alternative classification system that has been proposed. The size of our sample and the repeat assessments allows us not only to empirically determine the best groupings of symptoms, but also allows us to propose valid frequency cutoffs for binge eating and purging.