Rothenberg A
Harvard Medical School, Cambridge Hospital, Massachusetts.
Psychiatr Clin North Am. 1990 Sep;13(3):469-88.
Although it is widely recognized that eating disorders primarily begin during the adolescent period, the centrality of obsessive-compulsive symptomatology and dynamisms and their relationship to adolescent conflict and development has not been generally accepted or understood. Social pressures toward conformity with the ideal of feminine thinness, which are especially influential during the adolescent period, combine with obsessive-compulsive predispositions to produce eating disorder symptoms and patterns of behavior. Obsessive preoccupation with images of food as well as ruminative calorie counting, and ritualistic behavior regarding food, use of laxatives, and vomiting, together with an underlying focus on control, undoing and other obsessive-compulsive defenses, and a sado-masochistic orientation to the body all point to an essential obsessive-compulsive disorder. The presence of dysphoric affect and the erratic success of antidepressant medication with eating disorder patients has led to a belief in an underlying affective disorder. However, careful assessment of eleven studies presenting differential diagnostic data regarding anorexia nervosa reveals that noneating related obsessive-compulsive patterns and symptoms are second overall in incidence to depressive patterns and symptoms. With critical re-evaluation of data presented, the obsessive-compulsive condition equals or supersedes the depressive one in many samples. Moreover, given the intense achievement orientation of persons with obsessive-compulsive illness, along with other psychodynamic factors, depressive symptoms could well be considered a secondary breakdown effect. If the all-pervasive obsessive-compulsive nature of eating-related symptomatology discussed here is taken into consideration, depressive symptoms must be considered either secondary or incidental. As patients with eating disorders are notoriously secretive and oftentimes misleading about their symptoms and themselves, a diagnostic assessment of such patients in intensive treatment at a long-term hospital facility was carried out. Compared with a control group randomly selected from the remainder of the hospital patient population, obsessive-compulsive manifestations of rumination, ritualistic behavior, excessive cleanliness, excessive orderliness, perfectionism, miserliness, rigidity, and scrupulousness and self-righteousness were all significantly associated with the eating disorder patient group. The current eating disorder picture, therefore, appears to be a modern form of obsessive-compulsive illness beginning during the adolescent period.
尽管人们普遍认识到饮食失调主要始于青春期，但强迫症状和动力的核心地位及其与青少年冲突和发展的关系尚未得到普遍认可或理解。社会对符合女性瘦的理想标准的压力，在青春期尤其具有影响力，与强迫倾向相结合，产生饮食失调症状和行为模式。对食物形象的强迫性关注、反复的卡路里计算、与食物、使用泻药和呕吐有关的仪式行为，以及对控制、消除和其他强迫性防御的潜在关注，以及对身体的施虐受虐取向，都指向一种本质上的强迫症。烦躁情绪的存在以及抗抑郁药物对饮食失调患者的疗效不稳定，导致人们相信存在潜在的情感障碍。然而，对11项提供神经性厌食症鉴别诊断数据的研究进行仔细评估后发现，与饮食无关的强迫模式和症状在发病率上总体仅次于抑郁模式和症状。对所呈现的数据进行批判性重新评估后，在许多样本中，强迫状况等同于或超过了抑郁状况。此外，考虑到强迫性疾病患者强烈的成就取向以及其他心理动力学因素，抑郁症状很可能被视为继发性崩溃效应。如果考虑到这里讨论的与饮食相关症状的普遍存在的强迫性本质，那么抑郁症状必须被视为继发性或偶发性的。由于饮食失调患者对自己的症状和自身情况 notoriously secretive 且常常误导他人，因此在一家长期医院设施对这类患者进行了强化治疗中的诊断评估。与从医院其他患者群体中随机挑选的对照组相比，反刍、仪式行为、过度清洁、过度整洁、完美主义、吝啬、僵化、一丝不苟和自以为是等强迫性表现都与饮食失调患者组显著相关。因此，当前的饮食失调情况似乎是一种始于青春期的现代形式的强迫症。
