McAleavey Kristen
Longwood University, Farmville, Virginia, USA.
Adv Mind Body Med. 2008 Summer;23(2):18-26.
Conventional therapy for eating disorders has focused on behavioral approaches, medical models, and combinations of both, with lesser emphasis on psychological and wellness models. Because eating disorders are often difficult to treat and the individuals who have them often exhibit significant comorbidities, the long-term success rate (3-5 years or more)-defined as recovery and abstinence from the disorder behaviors-is in the 40% to 50% range, at best. Moreover, if one examines randomized controlled trials (RCTs) that test the efficacy of the most commonly used behavioral approaches in a historical manner, as is described in this article, by assigning RCTs to 2 different time periods for the treatment of bulimia nervosa (BN), it is found that no progress has been made in the success rate of treating this disorder. Many reasons exist for this lack of progress, including comorbidities, failure of patient-therapist relationships to be dynamic, failure to appreciate that BN and binge eating disorder have addiction components that might require 12-step or multimodal approaches, and an absence of treating the whole person, which requires using a wellness model and elements such as body awareness exercises, yoga, and spirituality. Based on a review of the literature and my personal experience over the last 10 years, it is suggested that best practices for treating these disorders should include wellness and 12-step models that focus less on self-centeredness, highlighting the strengths of the person and helping individuals to find their true spirituality, which can be used as a focal point for all treatment. Conventional approaches can still be useful in treating eating disorders, but clinicians and psychiatrists should cease seeing eating disorders as "diseases" that should be treated by pharmacodynamics and consider that these are conditions that have taken many years to develop and that have many background psychological factors, often reaching back to childhood.
饮食失调的传统治疗方法主要集中在行为疗法、医学模式或两者的结合上，对心理和健康模式的重视程度较低。由于饮食失调往往难以治疗，且患者常常伴有严重的共病，长期成功率（3至5年或更长时间）——定义为康复并戒除失调行为——充其量在40%至50%之间。此外，如果按照本文所述，以历史的方式审视测试最常用行为疗法疗效的随机对照试验（RCT），即将治疗神经性贪食症（BN）的RCT分为两个不同时间段，就会发现治疗该疾病的成功率并无进展。缺乏进展的原因有很多，包括共病、患者与治疗师关系缺乏动态性、未认识到BN和暴饮暴食症具有成瘾成分，可能需要采用12步或多模式方法，以及未对患者进行全面治疗，而这需要运用健康模式以及诸如身体意识训练、瑜伽和精神疗法等元素。基于对文献的回顾以及我过去十年的个人经验，建议治疗这些疾病的最佳实践应包括健康和12步模式，这些模式应减少对自我中心的关注，突出个人优势，帮助个体找到真正的精神寄托，并将其作为所有治疗的重点。传统方法在治疗饮食失调方面仍可能有用，但临床医生和精神科医生应不再将饮食失调视为可通过药效学治疗的“疾病”，而应认识到这些病症是多年形成的，存在许多背景心理因素，往往可追溯到童年时期。
