PowerPoint  Lecture Notes Presentation Chapter 9 Eating Disorders 飲食性疾患 Abnormal Psychology, Tenth Edition by Ann M. Kring, Gerald C. Davison, John M. Neale, & Sheri L. Johnson

Anorexia Nervosa心因性厭食症 Diagnostic criteria診斷準則 Refusal to maintain normal body weight拒絕維持正常體重 Less than 85% 低於預期體重85%以下 Intense fear of gaining weight and being fat強烈害怕體重增加或變胖 Fear not reduced by weight loss 體重降低其害怕仍不會減少 Distorted body image身體形象的扭曲 Feel “fat” even when emaciated 即使消瘦仍感覺肥胖 Amenorrhea 無月經症 Loss of menstrual period 無月經週期 Two types:兩種類型 Restricting 禁食型 Binge-eating-purging 暴食-清除型 Copyright 2005 John Wiley & Sons, NY

Copyright 2005 John Wiley & Sons, NY Table 9.1 Sample Items from Eating Disorders Inventory (EDI)飲食性疾患調查表的範例題 對瘦的需求 暴食 對體型不滿意 無能感 完美主義 人際上的不信任 身體內部感受 對成熟的害怕 Copyright 2005 John Wiley & Sons, NY

Figure 9.1Assessment of Body Image身體形象的衡鑑 Copyright 2005 John Wiley & Sons, NY

Anorexia Nervosa 心因性厭食症 Onset early to middle teen years初發年齡為青少年階段的早期到中期 Usually triggered by dieting and stress通常經由節食和壓力所引發 Women 10x as likely to develop disorder as men女性罹患此疾病的比例為男性的十倍 Often comorbid with depression, OCD, phobias, panic, alcoholism & PDs 常與憂鬱症,強迫症,恐懼症,恐慌症,酗酒和人格違常共病 Copyright 2005 John Wiley & Sons, NY

Physical Changes in Anorexia厭食症造成的生理改變 Low blood pressure, heart rate decrease, kidney & gastrointestinal problems低血壓,心跳減少,腎臟及胃腸道問題 Loss of bone mass骨質密度減少 Brittle nails, dry skin, hair loss易碎指甲,乾燥皮膚,髮量減少 Lanugo胎毛 Soft, downy body hair 柔軟,絨毛般的身體毛髮 Depletion of potassium & sodium鈉鉀離子的消耗 Can cause tiredness, weakness, and death可能造成疲勞,虛弱及死亡 Copyright 2005 John Wiley & Sons, NY

Copyright 2005 John Wiley & Sons, NY Prognosis預後 70% recover 有70%的心因性厭食症病患會痊癒 May take several years可能需要數年才能恢復 Relapse common復發很常見 Copyright 2005 John Wiley & Sons, NY

Bulimia Nervosa 心因性暴食症 Uncontrollable eating binges followed by compensatory behavior to prevent weight gain無法控制的暴食伴隨不當的補償行為防止體重增加 Occur at least 2x per week for 3 months每週至少發生兩次達三個月以上 Two types:兩種類型 Purging (vomiting, laxatives)清除型(如:嘔吐,或使用瀉藥) Non-purging (fasting, excessive exercise)非清除型(如:禁食或過度運動) Bulimia vs. Anorexia, binge-eating-purging type暴食症和厭食症的暴食-清除型之亞型比較 Extreme weight loss in anorexia 厭食症為體重過度降低 At or above normal weight in bulimia暴食症能維持正常體重或以上 Copyright 2005 John Wiley & Sons, NY

Bulimia Nervosa 心因性暴食症 Binges often triggered by stress and negative emotions 暴食行為通常經由壓力或負向情緒所引發 Typical food choices:主要選擇的食物 Cakes, cookies, ice cream, other easily consumed, high calorie foods蛋糕,餅乾,冰淇淋,以及其他容易取得且為高熱量的食物 Avoiding a craved food can increase likelihood of binge 避免渴望獲得的食物反而可能會增加暴食行為 Loss of control during binge在暴食發作當時感到失去控制 Shame and remorse often follow暴食行為之後感到羞恥與自責 Copyright 2005 John Wiley & Sons, NY

Bulimia Nervosa 心因性暴食症 Onset late adolescence or early adulthood初發年齡從青少年晚期至成年早期 Prevalence 1 – 2% 盛行率為1-2% 90% women 有9成的比例為女性 Comorbid with depression, PDs, anxiety, substance abuse, conduct disorder常與憂鬱症,人格違常,焦慮症,物質濫用和品行疾患共病 Suicide attempts & completions higher than in general population自殺嘗試和自殺完成率高於一般人口的自殺比例 Copyright 2005 John Wiley & Sons, NY

Physical Changes in Bulimia 心因性暴食症的生理變化 Menstrual irregularities月經的不規則 Potassium depletion鉀離子的耗損 Laxative use depletes electrolytes which can cause cardiac irregularities瀉劑的使用損耗電解質造成心跳的不規則 Loss of dental enamel from vomiting嘔吐行為造成牙齒琺瑯質的減少 Teeth appear “jagged”牙齒呈現鋸齒狀 Copyright 2005 John Wiley & Sons, NY

Copyright 2005 John Wiley & Sons, NY Prognosis預後 70% recover 有7成的心因性暴食症病患會痊癒 10% remain fully symptomatic 有1成的患者仍持續有症狀 Early intervention linked with improved outcomes 早期介入會有較佳的改善效果 Poorer prognosis when depression and substance abuse are comorbid 當與憂鬱症或物質濫用共病時伴隨較差的預後 Copyright 2005 John Wiley & Sons, NY

Binge Eating Disorder 暴食性飲食疾患 Diagnosis in need of further study 診斷需要更進一步的研究 Involves:包含有: Recurrent binges 再發性的暴食行為 2x per week for at least 6 months 每週兩次持續至少六個月 Loss of control during binge在暴食發作當時失去控制 Binge causes distress 暴食行為造成心理上的痛苦 No loss of weight or purging不會體重減輕或出現清除行為 Often accompanied by obesity通常伴隨肥胖 Body mass index (BMI) > 30 身體質量指數(BMI值)大於30 Copyright 2005 John Wiley & Sons, NY

Etiology of Eating Disorders: Genetics 飲食性疾患的病因學:遺傳 Family and twin studies support genetic link家族和雙生子研究支持遺傳與疾病之間的關聯 Higher MZ concordance rates for both anorexia and bulimia 厭食症、暴食症皆有很高的同卵雙生子的共患率 Body dissatisfaction, desire for thinness, binge eating, and weight preoccupation all heritable體型不滿意,對瘦的期望,暴食行為,以及對體重的專注都具有可遺傳性 Adoption studies needed 需要更進一步的領養研究 Linkage on chromosome 1 (Grice et al., 2002)與第一對染色體有關 Need for replication 需要再被驗證 Copyright 2005 John Wiley & Sons, NY

Etiology of Eating Disorders: Neurobiological Factors 飲食性疾患的病因學:神經生物因素 Hypothalamus not directly involved 與下視丘未有直接關聯 Low levels of endogenous opioids與低劑量的內生性類鴉片有關 Substances that reduce pain, enhance mood, & suppress appetite 此物質可降低痛苦,提升情緒以及抑制食慾 Released during starvation當處於飢餓狀態時會釋放 May reinforce restricted eating of anorexia 可能強化厭食症的禁食行為 Low levels of opioids in bulimia promote craving暴食症的低含量類鴉片能夠促進對吃食的渴望 Reinforce binging 增強暴食行為 Serotonin & dopamine may also play a role 血清素和多巴胺可能扮演一重要角色 Copyright 2005 John Wiley & Sons, NY

Table 9.2 The Restraint Scale 克制量表 Copyright 2005 John Wiley & Sons, NY

Etiology of Eating Disorders: Sociocultural Factors 飲食性疾患的病因學:社會文化因素 Societal emphasis on thinness 社會對瘦的強調 Dieting, especially among women, has become more prevalent 特別是對於女性而言,節食行為變得越來越普遍 Often precedes onset 通常在疾病初發前即有此現象 Body dissatisfaction and preoccupation with thinness also predict eating disorders 對身體的不滿意和對於瘦的專注想法可以用來預測飲食性疾患 Societal objectification of women leads to self-objectification 社會對女性的物化觀點導致自我物化 Unrealistic media portrayals fuel body dissatisfaction不切實際的媒體描繪促進個體對體型的不滿意 Copyright 2005 John Wiley & Sons, NY

Etiology of Eating Disorders: Cross Cultural Factors 飲食性疾患的病因學:跨文化因素 Anorexia found in many cultures在許多文化中可發現到厭食症的現象 Bulimia most common in industrialized, western countries暴食症在工業化西方國家中非常普遍 As countries become more industrialized, bulimia rates increase當國家變得愈工業化,暴食症比例更為增加 Preoccupation with thinness also culturally influenced對於瘦的要求通常受到文化所影響 Copyright 2005 John Wiley & Sons, NY

Etiology of Eating Disorders: Ethnic Factors 飲食性疾患的病因學:種族因素 White teens as compared to African American teens 白人青少年相比於非裔美國人的青少年 More body dissatisfaction 有更多的對身體的不滿意 BMI increases linked to greater body dissatisfaction 身體質量指數(BMI值)增加與更多的對身體不滿有關 More dieting 有更多的節食行為 White and Hispanic college students exhibit more body dissatisfaction than African American students白人和西班牙裔美國人的大學學生比非裔美國人學生有較多對身體的不滿 Socio-economic status 社經地位 Eating Disorders less linked to SES than in previous years飲食性疾患與社經地位的關聯性比過去數年較少 Copyright 2005 John Wiley & Sons, NY

Etiology of Eating Disorders: Psychodynamic View 飲食性疾患的病因學:心理動力觀點 Disturbed parent-child relationship 混亂的親子關係 Over-controlling parent 過度控制的父母 Dieting a means to gain control and identity (Baruch, 1980)節食為獲得控制和認同的一種方法 Conflicted mother-daughter relationship 衝突的母女關係 Bulimia creates a sense of self (Goodsitt, 1997) 暴食能夠產生自我控制感 Personality characteristics人格特質 Body dissatisfaction, lack of interoceptive awareness, and negative emotions (Leon et al., 1999)對身體的不滿,缺乏對身體內部感受的察覺和負向情緒 Perfectionism (Tyrka et al., 2002)完美主義 Copyright 2005 John Wiley & Sons, NY

Etiology of Eating Disorders: Family Characteristics 飲食性疾患的病因學:家庭特質 Disturbed family relationships 混亂的家庭關係 High levels of family conflict 較多的家庭衝突 Low levels of support 較少的支持 Family characteristics 家庭特質 May result from, not be a cause of, eating disorder 可能導致飲食性疾患但不一定為其成因 Not specific to eating disorders並不是飲食性疾患所特有的 Also found in families of individuals with other types of psychopathology 在其他類型心理病態的家庭中也發現到這些特質 Munching’s proposed family characteristics Munching提出的家庭特質 Enmeshment, overprotectiveness, rigidity, lack of conflict resolution 包括:過度糾結,過度保護,僵化,缺乏解決衝突的方式 Copyright 2005 John Wiley & Sons, NY

Etiology of Eating Disorders: Child Abuse 飲食性疾患的病因學:兒童虐待 High rates of childhood sexual and physical abuse高比例的個案在兒童期曾經受到性或身體上的虐待 Reports of abuse not specific to eating disorders 關於兒時受到虐待的報告,並不是在飲食性疾患所特有的 Also found in other diagnostic categories在其他的診斷類別中也發現到此現象 Copyright 2005 John Wiley & Sons, NY

Copyright 2005 John Wiley & Sons, NY Etiology of Eating Disorders: Cognitive Behavioral View 飲食性疾患的病因學:認知行為觀點 Anorexia厭食症 Focus on body dissatisfaction and fear of fatness著重在對身體的不滿與害怕變胖 Certain behaviors (e.g., restrictive eating, excessive exercise) negatively reinforcing特定行為(例如:限制飲食及過度運動)的負增強 Reduce anxiety about weight gain 降低對體重增加的焦慮 Feelings of self control brought about by weight loss are positively reinforcing 體重降低引發的自我控制感為正增強的部分 Criticism from family & peers regarding weight can also play a role家人或同儕對體重的批評也扮演一重要角色 Copyright 2005 John Wiley & Sons, NY

Copyright 2005 John Wiley & Sons, NY Etiology of Eating Disorders: Cognitive Behavioral View 飲食性疾患的病因學:認知行為觀點 Bulimia暴食症 Self-worth strongly influenced by weight 自我價值感受到體重所影響 Low self-esteem 低自尊 Rigid restrictive eating triggers lapses which can become binges 嚴格的限制飲食行為一旦失誤反而可能造成暴食行為 Many “off-limit” foods 許多“不該吃的”的食物 Restraint Scale measures dieting and overeating 克制量表用來測量節食與過度吃食的行為 Disgust with oneself and fear of gaining weight lead to compensatory behavior 對自我的厭惡和害怕變胖導致不當的補償行為 e.g., vomiting, laxative use 例如:催吐和使用瀉藥 Stress, negative affect trigger binges 壓力和負向情緒引發暴食行為 Copyright 2005 John Wiley & Sons, NY

Copyright 2005 John Wiley & Sons, NY Figure 9.2 Schematic of Cognitive Behavior Theory of Bulimia Nervosa心因性暴食症的認知行為理論圖解 經由節食以增加自我感 低自尊和高負向情感 節食行為的過度限制 暴食 節食行為被破壞 補償行為(例如:嘔吐)以降低 對體重增加的害怕 Copyright 2005 John Wiley & Sons, NY

Treatment of Eating Disorders 飲食性疾患的治療 Most individuals don’t receive treatment許多個案並沒有接受治療 Often deny problem 常否認自身問題 Antidepressants 抗憂鬱藥物 Effective for bulimia but not anorexia對暴食症有效但對厭食症則無作用 Drop out and relapse rates high個案放棄治療和再發機率高 Family therapy家族治療 CBT for bulimia 暴食症的CBT治療 Challenge societal ideals of thinness 挑戰社會對瘦的理想化觀點 Challenge beliefs about weight and dieting 挑戰關於體重和節食的信念 CBT more effective than medication 認知行為治療的效果勝過藥物治療 Copyright 2005 John Wiley & Sons, NY

Prevention of Eating Disorders 飲食性疾患的預防 Psychoeducational approaches 心理教育取向 De-emphasize sociocultural influences 減少對於社會文化觀點所造成影響的強調 Risk Factor Approach 危險因子取向 Identify those most at risk and intervene early 確認高風險的族群並早期介入 Copyright 2005 John Wiley & Sons, NY