Eiber R, Vera L, Mirabel-Sarron C, Guelfi J-D
Clinique des Maladies Mentales et de l'Encéphale, Hôpital Sainte-Anne, et Université René Descartes, Paris IV, Faculté de Médecine Cochin-Port-Royal, 75014 Paris.
Encephale. 2003 Jan-Feb;29(1):35-41.
Eating disorder patients evidenced very often a low self-esteem. Self-esteem in eating disorder patients is excessively based on body dissatisfaction. In eating disorders there seems to be a link between body image dissatisfaction and social anxiety. We hypothesised: self-esteem would be as low in eating disorder patients as in social phobia patients; self-esteem would be lower in eating disorder patients with social phobia than in patients with social phobia alone; self-esteem would be lower in eating disorder patients with depressive cognitions than in social phobia patients with depressive cognitions; self-esteem could have different characteristics in the two disorders; self-esteem would be as low in anorexia as in bulimia; 103 eating disorder patients (33 restrictive anorectics, 34 anorectics-bulimics, 36 bulimics) and 26 social phobia patients diagnosed according to DSM IV and ICD-10 criteria have been investigated by the Self-Esteem Inventory of Coopersmith, the Assertiveness Schedule of Rathus, the Fear Survey Schedule of Wolpe (FSS III) and the Beck Depression Inventory (BDI). Patients were free of medication and presented no episode of major depression according to DSM IV criteria. Evaluations took place before any psychotherapy. Self-esteem in eating disorder patients is reduced at the same level as in social phobia patients; 86.1% of the total sample and 84.5% of the eating disorder patients have a very low self-esteem (score 33 in the SEI). Eating disorder patients have significantly higher scores in the Social (p=0.016) and Professional (p=0.0225) sub-scales of the SEI than social phobia patients. Eating disorder patients show higher scores on the Assertiveness Schedule of Rathus (p=0.0013) than social phobia patients. Eating disorder patients disclose higher scores on the BDI (p=0.0003) but eating disorder patients with depressive cognitions do not differ from social phobia patients with depressive cognitions in the level of self-esteem. The FSS III scores are significantly lower in eating disorder patients (p<0.0001). There is a difference in the nature of the deficit of self-esteem between the two patient populations. Self-esteem is not influenced by the Body Mass Index (BMI) and is identically reduced in all groups of eating disorder patients. Whereas eating disorder patients have the same complaints compared to social phobia, they differ significantly from social phobia patients in their characteristics of social phobia and self-esteem.
饮食失调患者常常表现出低自尊。饮食失调患者的自尊过度基于对身体的不满。在饮食失调中，身体形象不满与社交焦虑之间似乎存在联系。我们提出假设：饮食失调患者的自尊水平与社交恐惧症患者一样低；伴有社交恐惧症的饮食失调患者的自尊低于仅患有社交恐惧症的患者；伴有抑郁认知的饮食失调患者的自尊低于伴有抑郁认知的社交恐惧症患者；自尊在这两种疾病中可能具有不同特征；厌食症患者的自尊与贪食症患者一样低。根据《精神疾病诊断与统计手册》第四版（DSM IV）和《国际疾病分类》第十版（ICD - 10）标准，对103名饮食失调患者（33名限制性厌食症患者、34名厌食 - 贪食症患者、36名贪食症患者）和26名社交恐惧症患者进行了调查，采用了库珀史密斯自尊量表、拉瑟斯自信量表、沃尔普恐惧调查量表（FSS III）和贝克抑郁量表（BDI）。患者未服用药物，且根据DSM IV标准未出现重度抑郁发作。评估在任何心理治疗之前进行。饮食失调患者的自尊降低程度与社交恐惧症患者相同；总样本中的86.1%和饮食失调患者中的84.5%自尊水平极低（SEI得分33分）。饮食失调患者在SEI的社交（p = 0.016）和职业（p = 0.0225）子量表上的得分显著高于社交恐惧症患者。饮食失调患者在拉瑟斯自信量表上的得分高于社交恐惧症患者（p = 0.0013）。饮食失调患者在BDI上的得分更高（p = 0.0003），但伴有抑郁认知的饮食失调患者与伴有抑郁认知的社交恐惧症患者在自尊水平上没有差异。饮食失调患者的FSS III得分显著更低（p < 0.0001）。这两类患者群体在自尊缺陷的性质上存在差异。自尊不受体重指数（BMI）影响，且在所有饮食失调患者组中降低程度相同。尽管饮食失调患者与社交恐惧症患者有相同的主诉，但他们在社交恐惧症特征和自尊方面与社交恐惧症患者有显著差异。
