进食障碍发病机制的研究进展与思考

进食障碍是一组典型而严重的心身疾病.随着现代医学模式的转变,生物-心理-社会因素对进食障碍的影响日益受到关注.本文拟从生物学、心理学、社会学因素方面,综述近年来国内外对进食障碍发病机制的最新研究,并结合哲学相关理论对进食障碍发病机制的研究进行探讨分析.     

西方家庭影响进食障碍的研究述评

家庭是进食障碍发展过程中一个重要的影响因素。已有众多西方学者采用各种方法对进食障碍和家庭之间的关系进行了研究。从时间发展脉络来看, Minuchin等学者首先对此进行了经典临床研究; 随后有众多量化研究出现, 对此可以依据不同的测量水平、研究变量和被试视角进行梳理; 近些年, 有学者采用质化研究方法重新对此进行探讨。进食障碍家庭研究的发展趋势表现出：重视本土化研究、对家庭做多水平的探讨、兼顾家庭结构和家庭变化过程。     

情绪智力在身体自尊与进食障碍倾向间的调节作用

采取整群抽样对1043名中学生进行问卷调查,主要探讨身体自尊、情绪智力与青少年进食障碍倾向之间的关系,检验情绪智力的调节作用。结果表明：（1）BMI、性别、年级和年龄均是青少年进食障碍倾向的预测因素。（2）青少年身体自尊负向预测其进食障碍倾向。（3）青少年情绪智力在身体自尊和进食障碍倾向之间起调节作用,具体来说,无论情绪智力高低,青少年身体自尊均显著预测其进食障碍倾向,然而,相对于高情绪智力被试,低情绪智力被试的身体自尊对其进食障碍倾向的预测力更大。     

进食障碍影响因素的探讨

神经性厌食症和神经性贪食症是主要的进食障碍症状。进食障碍的影响因素有社会文化因素（例如媒体和同伴的影响）、家庭因素（如困惑和冲突）、消极情绪、低自尊水平和对自身的不满及认知和生物方面的因素等。     

从强迫运动到进食障碍症状:依恋的中介效应

目的:考察在校大学生依恋关系在强迫运动与进食障碍症状之间的中介效应。方法:研究一和研究二采用问卷调查法分别对466名男大学生和334名女大学生的依恋焦虑、依恋回避水平、强迫运动和进食障碍临床症状进行考察,通过分层回归检验依恋焦虑和依恋回避在强迫运动与进食障碍症状间的中介效应,并用Bootstrap法对中介效应进行验证。结果:在男女大学生中强迫运动可显著预测进食障碍症状; 在男生当中,依恋的两个维度依恋焦虑和依恋回避在强迫运动与进食障碍间的部分中介作用显著; 在女生当中,仅依恋焦虑起到部分中介作用。结论:强迫运动是进食障碍症状的重要风险因子,可通过依恋关系的中介作用影响进食障碍症状,依恋关系对强迫运动与进食障碍症状之间关系的中介效应具有性别差异。     

体型知觉的准确性及其认知机制

体型知觉的准确性既和一般人群的心理健康水平有关, 又对进食障碍的理解、预防和治疗具有重要意义。首先, 进食障碍患者可能高估自己的身体, 其体型知觉准确度可能受其BMI和症状的影响, 并与患者预后相关。其次, 通过和对他人体型估计的结果进行对比发现, 对自己的体型的高估可能受到对自己身体态度因素的影响。第三, 一般人群对自己的体型估计的结果往往不一致, 这可能是体型知觉的不同量化方式所致。最后, 体型知觉准确性的相关认知机制主要有收缩偏差、视觉适应和序列依赖效应。     

大学生进食障碍症状的潜在剖面分析及其与抑郁的关系

为了解大学生进食障碍症状的类别特征及其与抑郁和性别的关系,使用进食障碍检查自评问卷6.0和9项患者健康问卷对575名大学生施测,采用带预测变量（抑郁）和分类结果变量（性别）的潜在剖面法进行数据分析。结果表明：大学生进食障碍症状可划分为体形关注组（62.4%）、体像顾虑组（28.0%）和进食障碍风险组（9.6%）;抑郁得分越高,个体被归为体像顾虑组或进食障碍风险组的可能性越大;女性属于体像顾虑组和进食障碍风险组的可能性比男性高。     

暴食症的诊断、治疗及其疗效

暴食症已成为目前世界上广泛流行的三大进食障碍之一,我国患者亦不在少数并有增加之势,但对暴食症的研究与治疗尚属起步阶段。文章回顾了暴食症的表征及其诊断技术,简要介绍了常见的三种治疗方法（即行为疗法、认知疗法及伴随症状改善法）,并讨论了影响暴食症疗效的诸个体因素。暴食症的诊断主要是根据美国精神疾病诊断与统计手册第四版（DSM-IV）、进食障碍检测评估表（EDE）（治疗者用）和患者用进食障碍检测问卷（EDE-Q）（患者用）,并结合过往病史和伴随症状。三类治疗方法在理论与操作层面各有倚重,均可收到一定治疗效果。但各疗法的效果与预后会因患者而异甚或迥乎相异,这是因为暴食症疗效还受到患者自身人格、社会和认知诸因素的影响,治疗者应根据特定患者选择适合该患者的疗法。     

完美主义与心理障碍的关系研究

完美主义是一种深刻影响人格的心理特征,与心理障碍有着极为密切的联系。完美主义是进食障碍、抑郁、强迫障碍、社交焦虑、人格障碍的风险和维持因素,这些心理障碍患者的完美主义得分显著高于健康控制组,在对这些心理障碍进行治疗时,应该对完美主义心理特征加以重视。完美主义的治疗对于改善与之相关的心理障碍的症状有着积极的意义。就完美主义与心理障碍的关系研究进行系统回顾,并对完美主义的认知-行为心理咨询的方法进行了阐述。     

日周期类型与心理健康

个体间表现出的昼夜节律差异现象可以从日周期类型上进行分类, 包括偏爱早睡早起的清晨型, 偏爱晚睡晚起的夜晚型以及处于两者之间的中间型。已有研究表明, 夜晚型与心境障碍、注意缺陷多动障碍和进食障碍等心理疾病有关, 而日周期类型与心理健康的关系可能受到基因、社会时差、人格等因素的影响。未来应改进研究设计和测量方法, 深入考察日周期类型与心理健康的关系及其作用机制, 以及在我国文化背景下推进日周期类型与心理健康的关系研究。     

“疑难杂症”与医学模式

那些长期困扰患者和医生、查不出病因又久治不愈的病症,被称为“疑难杂症”;然而部分“疑难杂症”并非真正的疑难杂症,而是在诊治疾病的过程中所用医学模式出现了问题,医生往往局限于生物医学模式,忽略患者的心理、社会因素。因此,医学模式应该从实际工作中进行转变,而不能仅仅局限于理论上。笔者就临床常见的“怪”现象、医疗对象的复杂性...     

青少年饮食失调：同伴的表现形式及作用机制

饮食失调在青少年群体中非常普遍, 同伴被认为是一种重要的影响因素。梳理其作用机制, 对青少年饮食失调的预防和干预有重要意义。研究表明, 同伴对青少年饮食失调具有消极影响, 主要表现为感知到的同伴行为、实际的同伴行为、身体不满意的中介作用、以及同伴质量的影响。研究者从直接、间接的角度就同伴对青少年饮食失调的作用机制及影响进行了阐释。未来的研究应深化研究内容, 如增加关于同伴影响的长期效应、同伴属性划分、影响路径作用大小以及同伴与饮食失调的其它社会影响因素间的交互作用等方面的研究。     

Moving From Efficacy to Effectiveness in Eating Disorders Prevention: The Sorority Body Image Program

Although eating disorders prevention research has begun to produce programs with demonstrated efficacy, many such programs simply target individuals as opposed to engaging broader social systems (e.g., schools, sororities, athletic teams) as participant collaborators in eating disorders prevention. Yet, social systems ultimately will be responsible for the real-world delivery of eating disorder prevention programs, suggesting that an important issue has yet to be addressed. Namely, it is unclear to what degree efficacious individual-focused eating disorder prevention programs remain effective when incorporated into critical social systems under real-world conditions. Over the past 5 years, we have collaborated with the campus sororities in the development of a sustainable eating disorders prevention program that is based on the prevention efficacy literature. This paper describes both challenges and helpful strategies that we encountered in tailoring an evidence-based eating disorders prevention program to the needs of a relevant social system.     

Disordered Eating in Women of Color: Some Counseling Considerations

There is little attention devoted to studying eating disorder symptoms in racially and ethnically diverse groups despite the fact that the prevalence rates among women of color for eating disorder symptoms are similar to those of European American women. This article reviews research related to eating disorders in women of color, including a discussion of sociocultural factors that could influence the manifestation of eating disorders in women of color. Considerations for counseling practice and research are provided.     

Influence of Mass Media on Body Image and Eating Disordered Attitudes and Behaviors in Females: A Review of Effects and Processes

This article reviews research on the effects of television and magazines on body image and on disordered eating attitudes and behaviors in females. Evidence from different types of studies in the fields of eating disorders, media psychology, health psychology, and mass communication indicates that mass media are an extremely important source of information and reinforcement in relation to the nature of the thin beauty ideal, its importance, and how to attain it. Although considerable research remains to be done, evidence is accumulating that repeated exposure to media and to both direct and indirect (via media's effects on peers, parents, coaches, physicians, etc.) pressures from media to be thin constitute risk factors for body dissatisfaction, concerns over weight and disordered eating behaviors in adolescent girls and young women. To guide further research, as well as the prevention and treatment of disordered eating, we present a figural summary of media effects that integrates moderating and mediating factors such as internalization of the thin beauty ideal, social comparison, and activation of the thinness schema. We argue that risk factor research, prevention, and treatment will benefit from systematic research designed to clarify how the impact of various mass media is shaped by source and receiver/perceiver factors.     

Genetics in eating disorders: state of the science

Eating disorders have been viewed as psychiatric illnesses that are strongly influenced by societal pressures towards thinness and attractiveness. Although the environmental context of these disorders must not be neglected, recent research in the area of genetic epidemiology suggests a substantial influence of genetic factors on liability to eating disorders. This review presents a synthesis of current knowledge about genetic factors implicated in the etiology of eating disorders.     

The self and eating disorders

In our review, we focus on self-related constructs in the context of eating disorders with four aims. First, we examine a variety of self-related constructs that have been theoretically and empirically linked to the development and course of eating disorders. In addition to the more well-researched constructs of self-esteem and self-efficacy, we also report on findings related to selflessness, contingent self-worth, self-objectification, ego-syntonicity, self-concept clarity, self-compassion, social comparison, self-oriented perfectionism/self-criticism, and narcissism. Second, we discuss self-related constructs that may be especially relevant to comorbidities common among those with eating disorders. Third, we review intervention and prevention programs where self-related constructs play a prominent role. Lastly, we share future research directions regarding self-related constructs and eating disorders that we believe will advance a deeper understanding of the role of the self in the eating disorders.     

The role of body image in the prevention of eating disorders

This article reviews theory and research pertaining to prevention of negative body image and eating disorders. Research derived from the social cognitive model (SCM) and non-specific vulnerability-stressor (NSVS) model indicates that sustained prevention effects for attitudes and behaviors are possible, but not easy to achieve or explain. These limitations are considered in the context of promising research derived from a third model, critical social perspectives (CSP). We conclude that (1) research on practice should aim beyond the examination of efficacy in order to clarify the active ingredients contributing to prevention; and (2) research informed by each of the divergent perspectives can be used to enrich theory and practice in the field of eating disorders prevention.     

Les troubles des comportements alimentaires chez des étudiants de première année : une étude prospective multigroupes

There is increasing use of the phrase “campus eating symptoms” to describe regular binge eating (together with frequent exercise, and occasional reliance on vomiting or laxatives), concerns about body image, depressive symptoms, stress, and university adjustment problems among students. Incidence of eating disorders in the early grades of university is increasing, and the period from age 17–19 years (peak of bulimia) which corresponds to the beginning of study at university is critical. Given the stressful environment that is the 1st academic year, it is useful to consider eating disorders risk factors.

Method

Our study is longitudinal. At the beginning, the participants consisted of 1110 freshmen. Data regarding adjustment to university, gender, body image, BMI, transactional variables (perceived stress and coping) and eating disorders (EAT-26) were collected. At T2 (end of academic year), 556 students were recruited to reassess their eating behaviours. The aim of the study was to test gender invariance of a theoretical eating disorders model including all these variables and eating disorders measured a year apart from a mixed population integrating the university for the first times. This model assumes that these variables exert direct effects on eating disorders as measured in time one who in turn will affect the stability of these troubles a year later. Although very little research include boys in the study of eating disorders, the results of our multi-group analysis support the idea of the existence of sex differences in eating disorder predictors: the only common predictor of eating disorders among girls and boys was the use emotion-focused coping. Among boys, the best predictors of eating disorders were problem-focused coping, and seeking social support. Among girls, our results revealed that body mass index, body image, and academic adjustment and stress were the predictors of eating disorders. Finally, we found a temporal stability of eating disorders. This study showed that personal and contextual aspects have a direct impact on students’ eating behaviour. However, among boys, neither body image nor perceived stress affect the eating behaviour but how they cope with stress. The gender gap in the explanation of eating disorders suggest to not exclude the male population in this type of study and to treat the data separately.     

Body image and eating disorders in older adults: a review

Researchers have shown body image to be an important part of a person's self-concept and have linked body dissatisfaction to various psychopathologies, most frequently eating disorders. However, the majority of the literature to date has focused on adolescents and college-aged samples, with little attention paid to the course of body image and eating disorders throughout the life span. The present article reviews the available literature on body image and eating disorders in older adults to understand more fully the unique presentation of body concerns and disordered eating across the life span. The authors address unique factors affecting body dissatisfaction and the development of eating disorders among older adults and offer directions for future research.