大学生社交焦虑对躯体变形障碍的影响：外表拒绝敏感性的中介作用

躯体变形障碍在大学生群体中具有较高的发病率,在其发展过程中,社交焦虑是重要的预测因素;然而两者潜在的中介机制却未得到研究者关注。本研究采用问卷调查法,旨在大学生 (N = 875)中探究外表拒绝敏感性在社交焦虑与躯体变形障碍之间的中介作用。结果发现： (1) 社交焦虑显著正向预测外表拒绝敏感性与躯体变形障碍,且外表拒绝敏感性显著正向预测躯体变形障碍; (2) 外表拒绝敏感性在社交焦虑与躯体变形障碍之间具有显著的部分中介作用。本研究发现,个体的社交焦虑可直接影响躯体变形障碍,也可通过提高外表拒绝敏感性间接影响。     

躯体疾病和抑郁障碍共病的诊断、评估及治疗原则

躯体疾病和抑郁障碍共病已经成为一个越来越严重的临床和全球公共健康问题.共病的躯体疾病与抑郁障碍之间存在着双向的联系,即一种疾病对另一种疾病的发生、发展、预后以及治疗有消极的作用.本文就躯体疾病和抑郁障碍共病的流行病学、临床评估、诊断及治疗原则作一综述.     

躯体形式障碍的优化诊治

躯体形式障碍是精神科常见的一种神经症,该病具有较高的发病率,占用了大量的医疗资源,但临床识别率和有效治疗率却相当低.围绕躯体形式障碍的特点及其优化诊治作一些探讨,利于提高社会和非精神科医生对该病的认识,减少医疗资源的过度消耗,使疾病得到早期有效治疗.     

躯体形式障碍的优化诊治

躯体形式障碍是精神科常见的一种神经症,该病具有较高的发病率,占用了大量的医疗资源,但临床识别率和有效治疗率却相当低。围绕躯体形式障碍的特点及其优化诊治作一些探讨,利于提高社会和非精神科医生对该病的认识,减少医疗资源的过度消耗,使疾病得到早期有效治疗。     

躯体形式障碍的社会心理学分析

本研究对躯体形式障碍患者的社会心理特点进行调查分析.按照中国精神障碍分类与诊断标准第3版（CCMD-3）,试验组躯体形式障碍患者51例,在社区分层抽样51人作为对照组,用防御方式问卷、多伦多述情障碍量表进行测量.试验组不成熟型防御方式明显高于对照组,成熟型防御方式低于对照组,差异有统计学意义;述情障碍总分高于对照组,差异有统计学意义.情绪表达障碍、不成熟心理防御方式和社会文化因素共同作用形成了躯体形式障碍发病机制中的社会心理原因.在预防与治疗中需加强心理干预,以有效预防疾病的发生和提高治疗效果.     

躯体症状障碍的特点及综合诊疗原则

从美国精神疾病诊断与统计手册第三版（DSM-Ⅲ）的躯体形式障碍,到甚至更早的诊断名称为DSM-5的躯体症状障碍,这类疾病的名称一直在变化;学界对躯体化症状的分类和定义也一直存在争议.进行分类和诊断的主要目的是为了治疗.本文从躯体症状障碍相关概念的变迁及本质特点入手,分析、总结躯体症状障碍的心理行为特点及接诊和治疗原则,以期对广大临床工作者治疗工作的开展有所帮助.     

中国的“身体沟通”和躯体症状障碍:一个文化和性别视角下的案例研究

传统医疗支援服务在治疗躯体形式障碍和躯体症状障碍(somatic symptom disorder,SSD)上收效甚微。这些患者经历着越注意身体的痛感越感到难受的恶性循环,他们对这些现象的负面解释导致自身形成关注于身体(身体形象,强化患者的自我意识/自我观察)的“担忧型认知风格”,导致身体感觉不适与过度唤醒。身体心理治...     

综合性医院中抑郁症患者述情障碍与躯体化症状的研究

1　前言　　综合性医院就诊者中心理障碍患者占 2 4 % ,其中抑郁症为 1 0 4 %。一部分抑郁症患者具有明显的躯体化症状 ,多以躯体病就诊 ;一部分抑郁症患者不具有明显的躯体化症状 ,以情绪障碍症状为主诉。国内已对心身疾病、神经症、物质依赖的抑郁症患者述情障碍进行研究 ,我们进一步研究抑郁症患者述情障碍与躯体化症状之间的关系。述情障碍 (ａｌｅｘｉｔｈｙｍｉａ)主要表现为对情绪状态描述困难 ,少幻想和实用性思维方法 ,人际关系僵化。述情障碍者难以区别情绪状态和躯体感觉 ,描述躯体不适较多 ,因为他们常过分关注自己的躯体感受 …     

军事应激障碍的评估与防治

军事应激障碍是部队常见的心理障碍,也是严重影响部队战斗力的主要因素。探讨军事应激障碍的评估方法和防治措施是军事心理学研究的重要内容。本文系统地回顾了国内外军事应激障碍的评估原则和方法,并结合过去的研究成果,提出了军事应激障碍的防治措施。目的是为我军制定切实可行的军事应激防治措施提供科学依据,以维护部队官兵的心理健康,提高部队的战斗力     

情绪障碍及其干预:心理表象的视角

心理表象在多种情绪障碍中均表现出病理性特点。研究者基于心理表象主要对创伤后应激障碍、抑郁心境、双相障碍情绪和社交焦虑进行了心理病理学解释,尤其关注闪回和过度概化记忆等两种典型症状,并且重视心理表象在情绪症状维持中的作用。概括而言,研究者强调记忆形成与提取过程的异常、认知与行为的保护性策略的负强化、对事件及自我的认知偏差等三类因素对情绪障碍的致病作用。目前,针对或运用心理表象的干预与训练方法包括减少消极表象、改变消极表象内容、提高积极表象能力、提高记忆的具体性等四类。未来应注重侵入性表象的功能分析以及相关的心理病理学模型研究,并拓展干预与训练研究。     

Modular Cognitive-Behavioral Therapy for Body Dysmorphic Disorder: A Randomized Controlled Trial

There are few effective treatments for body dysmorphic disorder (BDD) and a pressing need to develop such treatments. We examined the feasibility, acceptability, and efficacy of a manualized modular cognitive-behavioral therapy for BDD (CBT-BDD). CBT-BDD utilizes core elements relevant to all BDD patients (e.g., exposure, response prevention, perceptual retraining) and optional modules to address specific symptoms (e.g., surgery seeking).     

Assessing the Prevalence of Body Dysmorphic Disorder in an Ethnically Diverse Group of Adolescents

We investigated the prevalence of Body Dysmorphic Disorder (BDD) in an ethnically diverse sample of adolescents (N = 566) using the Body Image Rating Scale, a brief self-report measure for assessing body dissatisfaction. Results showed that adolescent girls were more dissatisfied with their bodies than adolescent boys, and that African-Americans of both genders were less dissatisfied with their bodies than Caucasians, Asians, and Hispanics. The interaction between gender and ethnicity was not significant. We found an overall prevalence for BDD of 2.2%. Although these are the first data on the prevalence of BDD in an ethnically diverse group of adolescents, they are consistent with the other study on the prevalence of BDD in a predominantly Caucasian group of college students.     

Sudden Gains in Internet-Based Cognitive Behavior Therapy for Body Dysmorphic Disorder

Sudden gains have been associated with better short- and long-term treatment outcomes in a number of psychiatric disorders. However, no studies to date have evaluated sudden gains in body dysmorphic disorder (BDD). We used data from a previous randomized controlled trial evaluating the efficacy of an Internet-based cognitive-behavior treatment (CBT) for BDD. The sample consisted of 47 adults diagnosed with BDD. We compared the treatment outcomes of sudden gainers vs. gradual gainers (i.e., treatment responders with no sudden gains) and non-sudden gainers (i.e., gradual gainers plus nonresponders) at posttreatment and 3, 12, and 24 months after the end of the treatment. Twelve (25.5%) participants experienced a sudden gain. Compared to non-sudden gainers and to gradual gainers, sudden gainers showed significantly larger improvements on the Yale-Brown Obsessive-Compulsive Scale modified for BDD at posttreatment (g = 1.23 and g = .91, respectively), and at 3-month (g = 1.23 and g = 1.00, respectively), 12-month (g = 1.12 and g = .91, respectively), and 24-month follow-up (g = 1.11 and g = .97, respectively). This translated into higher rates of treatment responders and remitters in the sudden gainers across all time points. The occurrence of sudden gains in Internet-based CBT for BDD is associated with favorable short- and long-term treatment outcomes. This suggests that a sudden improvement during the treatment could be a marker of good prognosis, while non-sudden—including gradual—gainers are more likely to need continued support or booster sessions. Early identification of patients who are not progressing as expected and subsequent tailoring of the delivered intervention has the potential to improve treatment outcomes in this group.     

An Evaluation of the Body Dysmorphic Disorder Symptom Scale as a Measure of Treatment Response and Remission in Psychotherapy and Medication Trials

The Body Dysmorphic Disorder Symptom Scale (BDD-SS) is a self-report tool that captures an array of representative behavioral and cognitive symptoms commonly displayed by individuals with BDD. The BDD-SS is regularly used among experts in the field, though its utility as a measure of treatment response has not yet been formally evaluated. Results from two clinical trials of BDD treatment were pooled from an archived database to create a sample of 220 BDD participants who received either psychosocial or medication-based interventions for BDD. We used baseline BDD-SS scores to describe psychometric properties, baseline correlations with other scales to examine the content validity of the BDD-SS, and longitudinal symptom data to evaluate capacity to detect clinically relevant change. Results indicated that the BDD-SS has good psychometric properties and is able to detect symptom change over time, although it showed lower rates of reliable change with treatment relative to the gold standard rater-administered Yale-Brown Obsessive-Compulsive Scale Modified for BDD (BDD-YBOCS). The BDD-SS offers meaningful information about treatment response in a self-report format and may be particularly useful to employ in clinical practice settings as a means of gathering symptom and treatment response data via self-report when rater-administered interviews are not feasible, although it may underestimate the extent of improvement with treatment.     

Effectiveness of Multimodal Treatment for Young People With Body Dysmorphic Disorder in Two Specialist Clinics

Body dysmorphic disorder (BDD) typically originates in adolescence and is associated with considerable adversity. Evidence-based treatments exist but research on clinical outcomes in naturalistic settings is extremely scarce. We evaluated the short- and long-term outcomes of a large cohort of adolescents with BDD receiving specialist multimodal treatment and examined predictors of symptom improvement. We followed 140 young people (age range 10–18) with a diagnosis of BDD treated at two national and specialist outpatient clinics in Stockholm, Sweden (n = 96) and London, England (n = 44), between January 2015 and April 2021. Participants received multimodal treatment consisting of cognitive behavior therapy and, in 72% of cases, medication (primarily selective serotonin reuptake inhibitors). Data were collected at baseline, posttreatment, and 3, 6, and 12 months after treatment. The primary outcome measure was the clinician-rated Yale-Brown Obsessive-Compulsive Scale Modified for BDD, Adolescent version (BDD-YBOCS-A). Secondary outcomes included self-reported measures of BDD symptoms, depressive symptoms, and global functioning. Mixed-effects regression models showed that BDD-YBOCS-A scores decreased significantly from baseline to posttreatment (coefficient [95% confidence interval] = -16.33 [-17.90 to -14.76], p<0.001; within-group effect size (Cohen’s d) = 2.08 (95% confidence interval, 1.81 to 2.35). At the end of the treatment, 79% of the participants were classified as responders and 59% as full or partial remitters. BDD symptoms continued to improve throughout the follow-up. Improvement was also seen on all secondary outcome measures. Linear regression models identified baseline BDD symptom severity as a predictor of treatment outcome at posttreatment, but no consistent predictors were found at the 12-month follow-up. To conclude, multimodal treatment for adolescent BDD is effective in both the short- and long-term when provided flexibly within a specialist setting. Considering the high personal and societal costs of BDD, specialist care should be made more widely available.     

Efficacy of Cognitive Therapy for Body Dysmorphic Disorder: A Randomized Controlled Pilot Trial

Dysfunctional cognitive processes and maladaptive interpersonal patterns have been postulated to maintain body dysmorphic disorder (BDD). The present trial evaluated CT for BDD (CT-BDD), which includes modules targeting maladaptive cognitive processing in BDD, as well as elements of schema therapy related to interpersonal problems. We investigated whether (a) CT-BDD is effective, as compared with a wait-list (WL) group at Week 12; (b) outcome of CT-BDD is maintained at posttreatment and 3- and 6-months follow-up; and (c) whether changes in shame and insight mediate changes in BDD symptom severity. Forty adults with BDD were randomized to 36 weeks immediate CT-BDD (n = 21), or to 12-week WL (n = 19). At Week 12, immediate CT-BDD was significantly superior to WL in clinician-rated BDD symptom severity, insight, self-reported BDD symptoms, shame, depression, general symptomatology, and life satisfaction. Changes in outcomes were associated with moderate to large effect sizes at Week 12. Reductions in shame and increase in insight separately mediated changes in BDD symptom severity during treatment at Week 12. From baseline to posttreatment, significant improvements occurred within CT-BDD in clinician-rated symptom severity, insight, depression, global functioning, self-reported BDD symptoms, shame, depression, general symptomatology, and life satisfaction. At posttreatment, improvements were associated with large effect sizes and were maintained at 3- and 6-month follow-up. Preliminary results support the efficacy of CT-BDD. Addressing interpersonal problems in addition to cognitive dysfunctions may increase the benefit of CBT for BDD patients.     

整形美容外科年轻医师的人文修炼

我国整形美容外科在迅速发展的同时还存在许多弊病,为了促进学科整体健康快速发展,整形美容外科的年轻医师除了精进专业技术,还必须进行必要的人文修炼。本文介绍并分析了整形美容外科面临的五个人文困境,指出整形美容外科年轻医师具有进行人文修炼的必要性,并提出人文修炼的三条途径。     

Body Dysmorphic Symptoms,Functional Impairment,and Depression: The Role of Appearance-Based Teasing

Body dysmorphic disorder is associated with elevated social and occupational impairment and comorbid depression, but research on risk factors for body dysmorphic symptoms and associated outcomes is limited. Appearance-based teasing may be a potential risk factor. To examine the specificity of this factor, the authors assessed self-reported appearance-based teasing, body dysmorphic, and obsessive-compulsive symptom severity, functional impairment (i.e., social, occupational, family impairment), and depression in a nonclinical sample of undergraduates. As hypothesized, appearance-based teasing was positively correlated with body dysmorphic symptoms. The correlation between teasing and body dysmorphic symptoms was stronger than that between teasing and obsessive-compulsive symptom severity. Last, body dysmorphic symptom severity and appearance-based teasing interacted in predicting functional impairment and depression. Specifically, appearance-based teasing was positively associated with depression and functional impairment only in those with elevated body dysmorphic symptoms. When a similar moderation was tested with obsessive-compulsive, in place of body dysmorphic, symptom severity, the interaction was nonsignificant. Findings support theory that appearance-based teasing is a specific risk factor for body dysmorphic symptoms and associated functional impairment.     

Empirically Defining Treatment Response and Remission in Body Dysmorphic Disorder Using a Short Self-Report Instrument

Determining response or remission status in body dysmorphic disorder (BDD) usually requires a lengthy interview with a trained clinician. This study sought to establish empirically derived cutoffs to define treatment response and remission in BDD using a brief self-report instrument, the Appearance Anxiety Inventory (AAI). Results from three clinical trials of BDD were pooled to create a sample of 123 individuals who had received cognitive-behavioral therapy for BDD, delivered via the Internet. The AAI was compared to gold-standard criteria for response and remission in BDD, based on the clinician-administered Yale–Brown Obsessive Compulsive Scale, modified for BDD (BDD-YBOCS), and evaluated using signal detection analysis. The results showed that a ≥ 40% reduction on the AAI best corresponded to treatment response, with a sensitivity of 0.71 and a specificity of 0.84. A score ≤ 13 at posttreatment was the optimal cutoff in determining full or partial remission from BDD, with a sensitivity of 0.75 and a specificity of 0.88. These findings provide benchmarks for using the AAI in BDD treatment evaluation when resource-intensive measures administered by clinicians are not feasible.