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。     

Eating behavior in obese BED, obese non-BED, and non-obese control participants: A naturalistic study

Laboratory studies have shown considerable differences between the eating behavior, particularly binge eating behavior, of participants with and without binge eating disorder (BED). However, these findings were not replicated in two field experiments employing ecological momentary assessment (EMA) in which obese BED and obese non-BED participants reported comparable binge eating behavior. In the current study, we examined differences in binge eating with an innovative assessment scheme employing both EMA and a standardized computer-based dietary recall program to avoid some of the limitations of past laboratory and field research. Obese BED, obese non-BED, and non-obese control participants reported significant differences in eating patterns, loss of control, overeating, and binge eating behavior. Of particular importance was the finding that BED participants engaged in more overeating and more binge eating episodes than non-BED participants. These findings suggest that the use of EMA in combination with dietary recall may be a relatively objective and useful approach to assessing binge eating behavior. The findings further suggest that individuals with BED are observably different from those without the disorder, which may have implications for eating disorder diagnoses in DSM-V.     

The cultural congruency effect: Culture, regulatory focus, and the effectiveness of gain- vs. loss-framed health messages

The present study contributes a cultural analysis to the literature on the persuasive effects of matching message frame to individuals’ motivational orientations. One experiment examines how members of cultural groups that are likely to differ in their regulatory focus respond to health messages focusing on either the benefits of flossing or the costs of not flossing. White British participants, who had a stronger promotion focus, were more persuaded by the gain-framed message, whereas East-Asian participants, who had a stronger prevention focus, were more persuaded by the loss-framed message. This cultural difference in persuasion was mediated by an interaction between individuals’ self-regulatory focus and type of health message. Thus health messages framed to be culturally congruent led participants to have more positive attitudes and stronger intentions to perform the health behaviors, and the interaction between self-regulatory focus and message frame emerged as the pathway through which the observed cultural difference occurs. Discussion focuses on the integration of individual difference, socio-cultural, and situational factors into models of health persuasion.     

The role of familiarity in dietary development

The rise in inadequate and unhealthily diets in children has led investigations to examine the development of food preferences. This review outlines the ways in which children choose between foods made available to them and the subsequent shaping of their own habitual diet. Children are liable to form preferences to certain hedonic foods, and to exhibit neophobic reactions to the unfamiliar. Unfamiliar foods can elicit anxiety and suspicion. Trust and liking of a once novel food can be gained through exposure, increasing familiarity towards that food. This review examines: visual familiarity (awareness of foods within their environment); taste familiarity (knowledge and experience of the taste of foods); contextual familiarity (knowledge of how foods should be presented); and categorical familiarity (which family foods belong to). The influence of familiarity is also explained with regards to both positive and negative associative learning. These associations are influenced by the specific presentation and the social environment of a novel food. The potential benefits of understanding the nature of children’s learning and preference development for the promotion of healthy nutrition to both parent and child are discussed.     

Health-Related Quality of Life in Women with Eating Disorders: Association with Subjective and Objective Binge Eating

This study examined health-related quality of life (QOL) and its association with different forms of binge eating in 53 women with eating disorders. Participants had enrolled in treatment for anorexia nervosa, bulimia nervosa, binge eating disorder, or other eating disorders not otherwise specified and completed measures of QOL, eating-related psychopathology, and mood disturbance. Eating- and mood-related psychopathology, and to a lesser extent, mental-component QOL scores, were severely impaired in this sample relative to population norms. QOL was significantly and independently predicted by subjective bulimic episodes and compensatory behaviors, including food avoidance, laxative abuse, and self-induced vomiting, accounting for 32% of the variance. Subjective bulimic episodes and food avoidance also independently predicted the physical-component QOL, accounting for 27% of the variance. These findings suggest that subjective bulimic episodes may be independently associated with impairment in QOL and may require specific attention as targets of treatment.     

The relationship between neuroticism and night eating: exploring the mediating roles of psychological distress and maladaptive coping

Night Eating Syndrome has been shown to be associated with various negative physical and psychological consequences. This study explored the relationship between neuroticism and night eating, which had not been studied before. We also examined the possible mediating roles of psychological distress and maladaptive coping for the relationship between neuroticism and night eating. A sample of 578 Chinese college students were assessed on several measures: The Revised Eysenck Personality Questionnaire Short Scale, the Night Eating Questionnaire, the Depression Anxiety Stress Scales, and the Simplified Coping Style Questionnaire. Results indicated that neuroticism was significantly and positively related to night eating (r = .38, p < .01), and the relationship between neuroticism and night eating was partially mediated by psychological distress, but not by maladaptive coping. The results not only revealed a medium-sized relationship between neuroticism and night eating, but also pointed out the importance of psychological distress as related to the relationship between neuroticism and night eating. Unlike neuroticism, which is a personality trait, psychological distress is an emotional state, and it is much more malleable through appropriate intervention. The treatment and intervention for night eating may benefit from our attention to the psychological distress.     

Relationship between Mental Health and Burden among Primary Caregivers of Outpatients with Schizophrenia

There is growing recognition that caring for a patient with schizophrenia often results in high levels of perceived burden and poorer overall mental health for caregivers. A quantitative cross‐sectional design and standardized instruments were used to collect data from 355 primary caregivers of adults in outpatient care with schizophrenia in China. Structural equation modeling was used to examine the association between caregiver burden and mental health among primary caregivers and whether this association is influenced by personality, coping style, and family functioning, based on a diathesis–stress perspective. Goodness‐of‐fit indices (χ²/df = 1.406, GFI = 0.919, CFI = 0.957, etc.) confirmed that the modified model fit the data well. In line with the diathesis–stress model, and with this study's hypotheses, we found that caregiver burden was significantly related to mental health outcomes directly. The final model showed that personality traits, coping style, and family function influenced the relationship between caregiver burden and mental health. The neuroticism personality traits have a direct effect on caregiver burden and family functioning in this sample. Coping style had a direct effect on the caregiver burden, and family functioning had a direct effect on the caregiver burden. Our final model about primary caregivers can be applied clinically to predict mental health outcomes from caregiver burden.     

Cross‐cultural,population‐based study on adolescent body image and eating distress in Japan and Finland

This cross‐sectional population‐based survey compares the prevalence of self‐reported body image and eating distress symptoms among adolescents in Japan and Finland, and associations between emotional/behavioral problems, body image and eating distress from a cross‐cultural perspective. The study included 1,840 Japanese and 1,135 Finnish 8th grade students. The self‐reported questionnaire included the Body Image and Eating Distress Scale and Strengths and Difficulties Questionnaire (SDQ). The female adolescents from both Finland and Japan reported much greater dissatisfaction with, and concern about, their bodies than the males and Japanese females expressed even higher distress than Finnish females. High levels of body image and eating distress were associated with psychiatric problems measured with the SDQ. There was a significant three‐way interaction effect of body image and eating distress, gender and country with SDQ peer problems and prosocial behavior.     

The relationships between socially prescribed perfectionism,in‐group affect,negative urgency,and disordered eating in women

Socially prescribed perfectionism (SPP) is often considered as a key risk factor for disordered eating (DE). However, current conceptualizations of SPP largely assume that this perfectionism pressure is non‐specific (i.e., a global pressure), despite research indicating that for females experiencing DE, female‐dominated groups impose this pressure (as a perceived norm). Furthermore, this relationship may be mediated by a negative reaction to this pressure, in the form of impulsivity (or negative urgency). To date, no research has investigated whether the relationship between SPP and DE is mediated by negative urgency, nor has there been research clarifying how in‐group identification relates to DE, independent of SPP and negative urgency. To address these gaps, we assessed these variables in 147 female dieters (M_age = 25.12 years, SD = 3.08) using a cross‐sectional design. Consistent with our hypotheses, negative urgency fully mediated the link between female‐based SPP and disordered eating, while female‐based in‐group affect (identification) was predictive of disordered eating (although the latter relationship was not sustained in a multiple regression model). These findings suggest that the SPP from other women may relate to DE through increasing negative urgency, and that the link between in‐group (female) affect and DE may be better explained by SPP's link to DE.     

‘I didn’t realise I was such a sausage’: men’s accounts of whole-body scanning,body image,and expected changes in health-related behaviours

Objective: Whole-body scanning is now available in stores to assist buyers in choosing well-fitting clothes. This study was designed to investigate men’s accounts of scanning, body image and expectations of behaviour change. Design: Ten men aged 18–39 years without histories of eating disorders or previous experience of whole-body scanning, took part in semi-structured interviews before and after scanning. Data were analysed using inductive thematic analysis. Results: Pre-scan, men’s body ideals were tall, slender and relatively muscular. Post-scan, seven reported looking shorter, fatter, thinner and/or less symmetrical than they hoped; three were pleasantly surprised by the images. Men were interested in scans as an objective view of their bodies and as a ‘wake-up call’ to motivate healthy behaviours. Five men intended to change their behaviour as a result of scanning, and repeat scanning was seen as a good way to monitor behavioural changes. Participants suggested that scanning may raise body concerns in other men, though downplayed impacts on their own body image. Conclusion: Whole-body scanning may encourage men to exercise and eat more healthily. However, men became more negative about their bodies as a result of seeing their body scans, so scanning needs to be carried out with supervision and support.