Morgan J F
Department of General Psychiatry, St. George's Hospital Medical School, London, UK.
Acta Obstet Gynecol Scand. 1999 Mar;78(3):233-9.
Eating disorders are common, responsive to treatment and affect women at a peak age of reproductive function, often presenting via gynecological and obstetric sequelae. The author wished to examine gynecologists' knowledge and attitudes towards them.
Following a pilot study, a questionnaire concerning eating disorders was designed covering aspects of diagnosis, characteristic gynecological manifestations, treatment, and attitudes. All gynecologists and obstetricians with more than 1 year of experience from four teaching hospitals in Australia and the United Kingdom were sent the anonymous, confidential postal questionnaire. One hundred and fifteen doctors replied, with a response rate of 86%.
Only 20% of respondents were confident of diagnosing eating disorders. Various diagnostic misconceptions were revealed; for example, 42% overestimated weight loss in anorexia nervosa by 20% or more, and 28% wrongly believed that a sense of strict dietary control' was a feature of bulimia nervosa. Clinicians had least knowledge of bulimia nervosa, underestimating its treatment response. Surprisingly, the greatest deficits in knowledge were of endocrinology and gynecological sequelae. For example, 79% underestimated amenorrhea in anorexia nervosa by 25%, and 85% wrongly believed that regular menses was characteristic of bulimia nervosa at normal weight. Consultants demonstrated significantly more knowledge than junior grades. Thirty-one percent of respondents held pejorative attitudes to eating disorders, which over-represented men (p=0.045) who were also more likely than women to see bulimia nervosa as untreatable (p=0.01).
The author suggests that these deficits might be addressed by development of simpler screening questionnaires for non-specialists, and elucidation of the interface between eating disorders and reproductive physiology.
饮食失调很常见，可通过治疗得到缓解，且在女性生殖功能的高峰期影响她们，常通过妇产科后遗症表现出来。作者希望研究妇科医生对饮食失调的认识和态度。
在一项试点研究之后，设计了一份关于饮食失调的问卷，涵盖诊断、典型妇科表现、治疗及态度等方面。向澳大利亚和英国四家教学医院中所有有超过1年经验的妇科医生和产科医生发送了匿名、保密的邮政问卷。115名医生回复，回复率为86%。
只有20%的受访者对诊断饮食失调有信心。揭示了各种诊断误解；例如，42%的人将神经性厌食症的体重减轻高估了20%或更多，28%的人错误地认为“严格饮食控制感”是神经性贪食症的一个特征。临床医生对神经性贪食症的了解最少，低估了其治疗反应。令人惊讶的是，知识方面最大的不足在于内分泌学和妇科后遗症。例如，79%的人将神经性厌食症的闭经低估了25%，85%的人错误地认为体重正常的神经性贪食症患者月经规律是其特征。顾问医生表现出的知识明显比初级医生多。31%的受访者对饮食失调持贬义态度，其中男性比例过高（p = 0.045），而且男性比女性更有可能认为神经性贪食症无法治疗（p = 0.01）。
作者建议，这些不足可通过为非专科医生制定更简单的筛查问卷以及阐明饮食失调与生殖生理学之间的联系来解决。
