تلاش برای درک تناقض بی اشتهایی عصبی بدون تحرک برای لاغری
|کد مقاله||سال انتشار||مقاله انگلیسی||ترجمه فارسی||تعداد کلمات|
|33741||2007||7 صفحه PDF||سفارش دهید||محاسبه نشده|
Publisher : Elsevier - Science Direct (الزویر - ساینس دایرکت)
Journal : Psychiatry Research, Volume 149, Issues 1–3, 15 January 2007, Pages 215–221
The “atypical” subgroup of women with anorexia nervosa not characterized by drive for thinness (DT) was studied. The study group comprised 151 anorectic patients (restrictor anorectics [AN-R], n = 74; binge-purging anorectics [AN-BP], n = 77). Subjects completed the following self-administered questionnaires: Eating Disorder Inventory-2 (EDI-2), Temperament and Character Inventory (TCI), State-Trait Anger Expression Inventory (STAXI), and Beck Depression Inventory (BDI). Patients were subdivided into three groups on the basis of body mass index (BMI) and DT score: AN-I with a BMI < 15 and DT < 7 (n = 24); AN-II with a BMI > 15 and DT < 7 (n = 34); and AN-III with a BMI < 17.5 and DT > 7 (n = 93). Patients belonging to the AN-III group had a more severe disorder and form of psychopathology based on their scores on several scales. No association emerged between personality disorders and any single subgroup. Three hypotheses emerge: (1) some patients (about 38%) deny DT and provide negative answers on the questionnaires; (2) patients without DT (even when malnourished) seem to show less severe psychopathologic and personality traits; and (3) patients without DT answer questions honestly, but they have developed a character structure that enables them to feel negative and ego-dystonic emotions regarding their condition. Implications for treatment are discussed.
About 50% of persons with eating disorders (EDs) have partial-syndrome EDs or “atypical” EDs; therefore the study of these forms is a relevant and often neglected field of research (Fairburn and Harrison, 2003). In the research literature, the term “atypical” (or partial-syndrome) EDs refers to those patients who do not meet all the criteria required for a DSM-IV diagnosis (Strober et al., 1999) but also to those full-syndrome cases of anorexia nervosa (AN) who meet DSM-IV criteria but do not show some of the core psychological features of AN from a dimensional point of view (atypical anorexia nervosa). For example, a key psychopathological role in AN is played by a morbid and strong fear of fatness (American Psychiatric Association, 2000) and by the consequent drive for and pursuit of thinness. This fear/drive is often measured by self-report questionnaires as a drive for thinness (DT; Garner, 1984), which is a psychological variable implicated in the etiology and course of EDs (Striegel-Moore et al., 1995 and Bizeul et al., 2001). Recent investigations found a subgroup of anorectic patients with full-syndrome AN, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994), but without a significant DT ( Ramaciotti et al., 2002). The percentage of patients within this subgroup is variable, ranging from 0% to 20% in clinical samples ( Ramaciotti et al., 2002 and Garfinkel and Dorian, 2001). This subgroup of patients is difficult to define and has received little attention in the literature ( Crow et al., 2002), although such patients display a clinical severity that requires treatment. Indeed, people with full-syndrome and partial-syndrome EDs usually do not differ with respect to DT ( Dancyger and Garfinkel, 1995). Interest in “atypical” anorectic patients increased after reports that patients with a low DT at baseline assessment have a more favorable outcome (Bizeul et al., 2001) and a less severe course (Strober et al., 1999). Some authors who investigated this subgroup did not distinguish between severely (body mass index < 15) and less severely (body mass index > 15) malnourished anorectic patients and did not focus on the personality characteristics of these subjects. Subjects with a body mass index (BMI) < 15 are so severely ill that an inpatient program is often necessary (American Psychiatric Association, 2000). Therefore, it seems a paradox that these patients do not have a high DT. This feature could be related to the difficulties in treating patients with AN associated with an ego-syntonic functioning of personality (Kaplan and Garfinkel, 1999). The a priori hypothesis of this study was that AN patients with low DT deny their DT and their fat phobia when their physical condition is severe (BMI < 15), whereas the so-called “atypical anorectics” could be those with low DT but a BMI > 15. The study explored differences in personality and psychological functioning subgroups of AN women with low BMI (< 15) with low DT, anorectic women with BMI > 15 with low DT, and anorectic women with high DT.