Weight Suppression, Dieting and Bulimia Nervosa: A Biobehavioral Study

描述(由申请人提供)：体重抑制、节食和神经性暴食症：一项生物行为研究。神经性暴食症(BN)是一种主要影响年轻女性的衰弱精神障碍。经验支持的治疗BN的方法已经确定，但只有不到一半的接受治疗的人实现了这种疾病的长期缓解，这可能是因为目前的治疗方法没有充分考虑到帮助维持这种疾病的变量。BN的心理社会模型强调节食作为暴饮暴食和排泄的近因。节食既有心理方面的，也有生物方面的，但现有的BN模型压倒性地专注于其心理影响。我们已经区分了饮食导致的长期能量失衡(体重抑制(WS)，或一个人有史以来最高体重与当前体重之间的差异)和短期能量失衡(当前节食以减肥或避免体重增加)。最近的研究表明，BN的WS水平升高，WS的程度预测了BN的各种特征及其临床病程的严重程度。对当前节食减肥的研究发现，在英国，节食与减少暴饮暴食有关，这一发现与这种疾病的流行模式相冲突。拟议的研究将检查BN患者WS和Cd的生物学(例如，能量消耗、神经内分泌和食欲激素)和行为(例如，暴饮暴食和排泄)的相关性。(在患有BN的人中，报告称为了避免体重增加而节食的人相对较少，但其生物学和行为相关性也将得到研究。)该项目将招募132名符合BN暂定DSM-V诊断标准的女性(德雷塞尔大学66名，哥伦比亚大学66名)。我们将测试这样的假设：1)Cd和WS升高将与代谢和食欲的生物学指标变化相关，2)WS将预测更多的暴饮暴食和通便，而Cd将预测较少的暴饮暴食，通过生态瞬时评估(EMA)测量，以及3)每日限食意图的实时评级较高将预测当天暴饮暴食的可能性降低，但随后几天暴饮暴食的可能性增加。所有参与者的评估将包括：体重和以前报告的最高体重(以计算WS)、饮食紊乱检查、14天的EMA以评估食物限制意图、暴饮暴食和通便发作、三次24小时食物召回，以及静息能量消耗、代谢和食欲激素(包括完整的甲状腺面板、瘦素、Ghrelin、皮质醇和雌二醇)。参与者将被要求在6个月后返回进行后续体重评估。这项研究将阐明两种常见但在很大程度上未被探索的节食类型如何影响BN患者的生物学和行为变量，这可能导致BN流行模式的修改和改善治疗结果的新策略。

DESCRIPTION (provided by applicant): Weight Suppression, Dieting and Bulimia Nervosa: A Biobehavioral Study. Bulimia nervosa (BN) is a debilitating psychiatric disorder that primarily affects young women. Empirically supported treatments for BN have been identified but less than half of treated individuals achieve long-term remission from the disorder, possibly because current treatment approaches do not sufficiently account for variables that help maintain the disorder. Psychosocial models of BN emphasize the role of dieting as a proximal cause of binge eating and purging. Dieting has both psychological and biological facets but existing models of BN have overwhelmingly focused on its psychological impact. We have differentiated between a diet-induced long-term energy imbalance (weight suppression (WS), or the difference between one's highest-ever body weight and current weight) and a short-term energy imbalance (current dieting to either lose weight or avoid weight gain). Recent research has shown that WS levels in BN are elevated and that degree of WS predicts the severity of various BN characteristics and its clinical course. Studies of current dieting (CD) to lose weight have found that it is associate with reduced binge eating in BN, a finding that conflicts with prevailing models of the disorder. The proposed research will examine biological (e.g., energy expenditure, neuroendocrine and appetitive hormones) and behavioral (e.g., binge eating and purging) correlates of WS and CD in those with BN. (Relatively few of those with BN report dieting to avoid weight gain but its biological and behavioral correlates will also be examined.) The project will recruit 132 women (66 at Drexel University and 66 at Columbia University) meeting provisional DSM-V diagnostic criteria for BN. We will test the hypotheses that 1) CD and elevated WS will be associated with alterations in biological indices of metabolism and appetite, 2) WS will predict greater binge eating and purging, and CD will predict less binge eating, measured using Ecological Momentary Assessment (EMA), and 3) higher real time ratings of daily food restriction intentions will predict a reduced probability of binge eating during the same day but an increased probability of binge eating in subsequent days. Assessments for all participants will include: weight and reported previous highest weight (to calculate WS), the Eating Disorders Examination, 14 days of EMA to assess food restriction intentions, binge eating and purging episodes, three 24-hr food recalls, and resting energy expenditure and metabolic and appetitive hormones (including complete thyroid panel, leptin, ghrelin, cortisol and estradiol). Participants will be asked to return 6 months later for follow-up assessments of weight. This study will elucidate how two common yet largely unexplored types of dieting influence biological and behavioral variables in patients with BN, which could lead to modifications of prevailing models of BN and new strategies for improving treatment outcome.