Where do Eating Disorders belong in the Diagnostic Taxonomy?

描述（由申请人提供）：最近的研究表明，精神障碍的维度，层次模型比分类疾病分类学具有明显的优势。似乎这样的模型能够更好地解释在许多心理障碍中观察到的过度诊断共病、诊断稳定性差和可靠性弱。然而，在将定量模型应用于DSM的后续版本之前，必须对其进行扩展和改进。具体来说，更多的疾病需要纳入精神病理学的结构分析，因为大多数DSM诊断已被排除在现有的模型。也许精神疾病分层模型中最严重的遗漏是进食障碍，这与任何类型的精神疾病的死亡率最高有关。该项目的长期目标是扩大以前提出的精神疾病模型，特别侧重于饮食失调。具体目的是（1）确定厌食症和暴食症综合征在精神疾病的现存分层模型中的位置，（2）通过包括更多种类的轴I和II障碍来扩展精神疾病的现存模型，以促进进食障碍在分层结构中的正确定位，以及（3）检查在进食障碍症状和其他精神病理症状之间共享的倾向性因素，以便在症状水平上复制和扩展结构模型。如果新纳入的障碍不能完全符合现有的模型，这项研究将导致修订的DSM相关的精神障碍的层次模型。调查将分两个阶段进行。第1阶段将包括对来自科摩罗全国调查-重复调查（N= 5，692）的参与者进行回顾性分析，并将解决具体目标1和2。第2阶段是一项新的研究，将在从爱荷华州大学招募的大学生样本（N=400）中进行，并将解决具体目标3。拟议的一系列研究将是第一个将饮食失调纳入精神疾病分层模型的研究。总的来说，具有全国代表性的大型数据集与ESTA级数据相结合，有可能增加我们对饮食和相关疾病的地形和病因的理解。特别是，纳入额外的疾病可能会导致DSM类别和亚型的诊断有效性增加，并可能有助于进食障碍的分子和行为遗传学研究，特别是如果遗传因素包括对其他形式的精神疾病的易感性。因此，这条线的研究将导致一个更全面的经验为基础的系统的精神病理学相关的DSM分类的障碍。

DESCRIPTION (provided by applicant): Recent studies suggest that a dimensional, hierarchical model of mental disorders has clear advantages over a categorical nosology. It appears that such a model is better able to account for the excessive diagnostic comorbidity, poor diagnostic stability, and weak reliability observed in many psychological disorders. However, before a quantitative model can be applied to a subsequent edition of the DSM, it must be broadened and refined. Specifically, more disorders need to be included in structural analyses of psychopathology because the majority of DSM diagnoses have been excluded from existing models. Perhaps the most serious omission from hierarchical models of mental illness are the eating disorders, which are associated with the highest mortality rate of any class of psychiatric disorders. The long-term objective of this project is to to expand previously proposed models of mental illness, with a specific focus on eating disorders. The Specific Aims are to (1) determine where anorexic and bulimic syndromes fit into extant hierarchical models of mental illness, (2) expand extant models of mental illness by including a greater variety of Axis I and II disorders, in order to facilitate the correct placement of eating disorders within the hierarchy, and (3) examine the dispositional factors that are shared between eating disorder symptoms and other psychopathological symptoms in order to replicate and extend structural models at the syndrome- level. If the newly included disorders do not fit cleanly into extant models, this research will result in a revised hierarchical model of mental disorders relevant to the DSM. This investigation will be conducted in two phases. Phase 1 will consist of a retrospective analysis of participants from the National Comorbidity Survey - Replication (N=5,692) and will address Specific Aims 1 and 2. Phase 2 represents a novel study that will be conducted in a large student sample (N=400) recruited from the University of Iowa and will address Specific Aim 3. The proposed set of studies will be the first to include eating disorders among hierarchical models of mental illness. Taken together, the large nationally representative dataset in combination with symptom-level data has the potential to increase our understanding of the topography and etiology of eating and related disorders. In particular, the inclusion of additional disorders could lead to increased diagnostic validity of DSM categories and subtypes and may contribute to molecular and behavior genetic studies of eating disorders, particularly if heritable factors include susceptibility to other forms of mental illness. Thus, this line of research will lead to a more comprehensive empirically based system of psychopathology relevant to the DSM classification of disorders.