Natural course of Bulimia Nervosa and of eating disorder not otherwise specified: 5-year prospective study of remissions, relapses, and the effects of personality disorder psychopathology
Natural course of Bulimia Nervosa and of eating disorder not otherwise specified: 5-year prospective study of remissions, relapses, and the effects of personality disorder psychopathology
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DOI：
10.4088/jcp.v68n0511
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发表时间：
2007-05-01
影响因子：
5.3
通讯作者：
Stout, Robert L.
中科院分区：
文献类型：
--
作者：
Grilo, Carlos M.;Pagano, Maria E.;Stout, Robert L.
目的：前瞻性地研究神经性贪食症和进食障碍的自然过程中，没有另外说明（EDNOS）和测试人格障碍的精神病理学的缓解和复发的影响。方法：受试者是92名女性患者，目前神经性贪食症（N = 23）或EDNOS（N = 69）在基线招募的合作纵向人格障碍研究。轴I精神障碍（包括进食障碍）采用DSM-IV轴I疾病结构化临床访谈-患者版进行评估，人格障碍采用DSM-IV人格障碍诊断访谈（DIPD-IV）进行评估。在6个月和12个月时使用纵向间隔随访评估评估进食障碍的病程，并使用DIPD-IV的随访版本评估人格障碍的病程，然后每年评估一次，直至60个月。结果：神经性贪食症60个月缓解率为74%，EDNOS为83%，缓解后复发率为47%，EDNOS为42%。有和没有人格障碍的患者在缓解的概率上没有差异。考克斯比例风险回归分析显示，神经性贪食症和EDNOS在缓解时间上没有显著差异，人格障碍合并症不能显著预测缓解时间。使用随时间变化的协变量的比例风险回归分析显示，人格障碍的尺寸变化是最低限度的缓解或复发在这些饮食disorders.Conclusions：5年的自然过程中神经性贪食症和EDNOS差异不大，两种饮食障碍类别表现出类似的模式缓解和复发。这些发现表明EDNOS的临床意义，以及对这种最常见但研究最少的饮食失调症进行进一步研究的必要性。神经性贪食症和EDNOS的自然病程似乎不受共同发生的人格障碍精神病理学的存在、严重程度或随时间变化的变化的显著影响。
Objective: To examine prospectively the natural course of bulimia nervosa and eating disorder not otherwise specified (EDNOS) and to test for the effects of personality disorder psychopathology on remission and relapse.Method: Subjects were 92 female patients with current bulimia nervosa (N = 23) or EDNOS (N = 69) at baseline enrollment in the Collaborative Longitudinal Personality Disorders Study. Axis I psychiatric disorders (including eating disorders) were assessed with the Structured Clinical Interview for DSM-IV Axis I Disorders-Patient Version, and personality disorders were assessed with the Diagnostic Interview for DSM-IV Personality Disorders (DIPD-IV). The course of eating disorders was assessed with the Longitudinal Interval Follow-Up Evaluation and the course of personality disorders with the Follow-Along version of the DIPD-IV at 6 and 12 months and then yearly through 60 months. The study was conducted from July 1996 through June 2005.Results: Probability of remission by 60 months was 74% for bulimia nervosa and 83% for EDNOS, and probability of relapse among those with a remission was 47% for bulimia nervosa and 42% for EDNOS. Patients with and without personality disorders did not differ in probability of remission. Cox proportional hazards regression analyses revealed that bulimia nervosa and EDNOS did not differ significantly in time to remission and that personality disorder comorbidity did not significantly predict time to remission. Analyses using proportional hazards regression with time-varying covariates revealed that dimensional changes in personality disorders were minimally related to either remission or relapse in these eating disorders.Conclusions: The 5-year natural course of bulimia nervosa and EDNOS differed little with both eating disorder categories showing similar patterns of remissions and relapses. These findings suggest the clinical significance of EDNOS and the need for further research on this most common but least studied eating disorder. The natural course of bulimia nervosa and EDNOS does not appear to be influenced significantly by the presence, severity, or time-varying changes of co-occurring personality disorder psychopathology.