Where do Eating Disorders belong in the Diagnostic Taxonomy?

描述（由申请人提供）：最近的研究表明，一个维度的、层次的精神障碍模型比一个分类的疾病分类学有明显的优势。这种模型似乎能够更好地解释在许多心理障碍中观察到的过多的诊断合并症、诊断稳定性差和可靠性弱。然而，在数量模型可以应用于DSM的后续版本之前，必须扩大和完善它。具体来说，需要将更多的疾病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模型之外。也许在精神疾病的等级模型中最严重的遗漏是饮食失调，它与任何一类精神疾病的最高死亡率有关。该项目的长期目标是扩展先前提出的精神疾病模型，特别关注饮食失调。具体目标是：(1)确定厌食症和贪食症在现有的精神疾病层次模型中的适用范围；(2)通过包括更多种类的I轴和II轴疾病来扩展现有的精神疾病模型，以促进饮食失调在层次结构中的正确定位；(3)检查饮食失调症状和其他精神病理症状之间共有的性格因素，以便在综合征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，这项研究将导致与DSM相关的精神障碍的修订层次模型。这项调查将分两个阶段进行。第一阶段将包括对来自国家共病调查-复制（N= 5692）的参与者的回顾性分析，并将解决具体目标1和2。第二阶段是一项新颖的研究，将在从爱荷华大学招募的大量学生样本（N=400）中进行，并将解决具体目标3。这组研究将首次将饮食失调纳入精神疾病的分层模型。综上所述，具有全国代表性的大型数据集与症状水平数据相结合，有可能增加我们对饮食及相关疾病的地形和病因的理解。特别是，纳入其他疾病可能导致DSM类别和亚型的诊断有效性增加，并可能有助于饮食失调的分子和行为遗传研究，特别是如果遗传因素包括对其他形式精神疾病的易感性。因此，这条研究路线将导致与DSM疾病分类相关的更全面的基于经验的精神病理学系统。

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.