In Reply We thank King and Ehrlich for their thoughtful Letter critiquing our meta-analysis¹ that examined delay discounting as a transdiagnostic process in psychiatric disorders. In our article, we proposed that delay discounting, an index of impulsive decision-making, falls on a continuum. At the aggregate level, most disorders examined (eg, major depressive disorder, bipolar disorder, schizophrenia, borderline personality disorder, binge-eating disorder, and bulimia nervosa) exhibited steeper, more impulsive, delay discounting compared with controls, whereas people with anorexia nervosa exhibited shallower, less impulsive, discounting compared with controls. We discussed that excessively shallow discounting in anorexia nervosa is consistent with clinical symptoms of the disorder, including excessive control over food intake. King and Ehrlich raised an important concern about analyzing anorexia nervosa as a unitary disorder instead of examining 2 potentially important factors: (1) clinical subtype (eg, restricting vs binge eating/purging) and (2) association of current weight status (eg, acute underweight vs weight restored) with outcomes. King and Ehrlich suggested that a more specific analysis would reveal that shallow discounting is limited to patients with restricting subtype who have acute underweight.

在答复中我们感谢金和埃里希的深思熟虑的信，这些信批评了我们的荟萃分析¹他们研究了延迟贴现作为精神疾病的一种诊断方法。在我们的文章中，我们提出延迟折扣是一种冲动决策的指标，它属于连续体。从总体上看，与对照相比，大多数检查的疾病（例如重度抑郁症，双相情感障碍，精神分裂症，交际型人格障碍，暴饮暴食症和神经性贪食症）表现出更陡峭，更冲动，延迟的折扣。与对照组相比，表现出更浅，更少的冲动，打折。我们讨论了神经性厌食症中过度浅的折减与该疾病的临床症状相一致，包括对食物摄入量的过度控制。King和Ehrlich提出了将神经性厌食症分析为单一性疾病的重要关注点，而不是研究2个潜在的重要因素：（1）临床亚型（例如，限制饮食与暴饮暴食/暴饮暴食）和（2）当前体重状况的关联（例如，急性体重不足与体重减轻之间的关系）。King和Ehrlich建议进行更具体的分析，表明浅层折扣仅限于患有严重体重过轻的限制性亚型患者。