Devlin Michael J
Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York, USA.
Int J Eat Disord. 2007 Nov;40 Suppl:S83-8. doi: 10.1002/eat.20430.
To revisit the merits and problems inherent in considering obesity, or some aspect of obesity, as a mental or behavioral disorder.
The author suggests shifting the focus from the state of obesity to the process of nonhomeostatic overeating that results in obesity. Studies are reviewed that pertain to various models of nonnormative overeating including eating disorder models that stress the form of overeating, substance use disorder models focusing on its consequences, and affect regulation or stress response models focusing on its function.
Studies focusing on abnormal eating patterns, including binge eating and night eating suggest that such patterns may be related to the development of obesity. While the literature pertaining to substance use and other models of nonhomeostatic overeating is beginning to mount, current evidence is mostly preliminary and indirect.
An attempt to devise diagnostic criteria based on the above models raises multiple difficulties, since the phenomena central to each model are dimensional, common, and variably associated with distress or dysfunction. A detailed understanding of the neurobiological relationships among eating behavior, reward systems, and affect regulation systems will enable a more meaningful consideration of these models and will facilitate specific treatment for disorders of overeating.
重新审视将肥胖或肥胖的某些方面视为精神或行为障碍所固有的优点和问题。
作者建议将重点从肥胖状态转移到导致肥胖的非稳态暴饮暴食过程。回顾了与各种非规范性暴饮暴食模型相关的研究，包括强调暴饮暴食形式的饮食失调模型、关注其后果的物质使用障碍模型以及关注其功能的情绪调节或应激反应模型。
关注异常饮食模式（包括暴饮暴食和夜间进食）的研究表明，这些模式可能与肥胖的发展有关。虽然有关物质使用和其他非稳态暴饮暴食模型的文献开始增多，但目前的证据大多是初步的和间接的。
基于上述模型制定诊断标准的尝试引发了多重困难，因为每个模型的核心现象都是多维度的、常见的，并且与痛苦或功能障碍存在不同程度的关联。对饮食行为、奖励系统和情绪调节系统之间神经生物学关系的详细理解，将有助于更有意义地考虑这些模型，并促进对暴饮暴食障碍的具体治疗。
