Mills I H, Medlicott L
Department of Medicine, University of Cambridge, Addenbrooke's Hospital.
Q J Med. 1992 Jul;83(303):507-22.
A number of anorexic young women develop bulimia, a condition in which binge eating is driven so intensely they cannot resist it. Although this drive has the character of a compulsion the patients do not as a rule suffer from obsessional-compulsive neurosis. A questionnaire was developed and used to determine whether similar compulsive drives manifest themselves in restricting anorexics and whether there are compulsive features resembling patients with compulsive personality disorder (as described in DSM-III) in eating disorders. A total of 162 patients were studied, comprising 42 controls, 30 depressed patients, 34 non-bingeing anorexics, 28 bingeing anorexics and 28 compulsive patients. The questionnaire was shown to be a stable instrument and, on the compulsion scale, the anorexics, bulimics and compulsive patients all scored very highly (mean +/- S.E.; 32.1 +/- 1.9, 35.8 +/- 1.9, 28.0 +/- 2.2, respectively) compared to the controls (13.1 +/- 1.1, p < 0.005). The compulsive patients did not have anorexia-type eating disorders. It was concluded that many of the factors which underlie compulsive personality disorder are present in primary eating disorders and the compulsive nature of anorexia could not be ignored when treatment was considered. The difference between compulsive behaviour and addiction is discussed in the light of the failure of long-term naloxone infusion to cure severe anorexia, even though some patients had dramatic weight gains associated with the antilipolytic action of naloxone.
许多厌食的年轻女性会发展成贪食症，这是一种暴饮暴食的冲动非常强烈以至于她们无法抗拒的病症。尽管这种冲动具有强迫的特征，但患者通常并不患有强迫性神经症。设计了一份问卷，用于确定类似的强迫性冲动是否在限制型厌食症患者中表现出来，以及饮食失调患者中是否存在类似于强迫型人格障碍患者（如《精神疾病诊断与统计手册第三版》中所描述）的强迫特征。总共研究了162名患者，包括42名对照组、30名抑郁症患者、34名非暴饮暴食型厌食症患者、28名暴饮暴食型厌食症患者和28名强迫型患者。该问卷被证明是一种稳定的工具，在强迫量表上，厌食症患者、贪食症患者和强迫型患者的得分都非常高（平均值±标准误；分别为32.1±1.9、35.8±1.9、28.0±2.2），相比之下对照组为13.1±1.1（p<0.005）。强迫型患者没有厌食症类型的饮食失调。得出的结论是，强迫型人格障碍的许多潜在因素存在于原发性饮食失调中，在考虑治疗时不能忽视厌食症的强迫性质。鉴于长期输注纳洛酮未能治愈严重厌食症，尽管一些患者因纳洛酮的抗脂解作用体重显著增加，文中讨论了强迫行为与成瘾之间的区别。
