Asami Tomokuni, Okubo Yoshiro, Sekine Mizuho, Nomura Toshiaki
Department of Psychiatry, Hachioji Medical Prison Hospital, 2-26-1 Koyasu, Hachioji, Tokyo 192-0904, Japan.
BMC Psychiatry. 2014 Jun 7;14:169. doi: 10.1186/1471-244X-14-169.
Shoplifting is a serious problem among patients with eating disorders. For more than a decade, we have treated many patients with eating disorders incarcerated in Hachioji Medical Prison only for repeated shoplifting.
We analyzed the prison records and medical records of female psychiatric patients transferred to Hachioji Medical Prison between 2002 and 2011. Based on the offense listed at the time of sentencing, we extracted a shoplifting group and a drug-offense group from among all patients with eating disorders. One patient from the former group who had used substances and two from the latter group who had never shoplifted were excluded from the study. The groups had 41 and 14 patients, respectively. A control group comprised patients with other mental disorders (n = 34). We compared eating disorder histories and subtypes, weight changes, comorbidities, life histories, past behavioral problems, and clinical behavioral problems among the three groups.
The shoplifting group exhibited less impulsive behavior, substance abuse, antisocial features, borderline personality disorder, and past bulimia than did the drug-offense and control groups. The shoplifting group had higher educational achievement and steadier employment; however, their eating disorder histories and interpersonal dysfunction were more severe, and they had a higher psychiatric treatment dropout rate. There were also significant relationships with low body weight, anorexia nervosa-restricting type, obsessive-compulsive behaviors, and obsessive-compulsive personality disorder in the shoplifting group. During the clinical course, food refusal, excessive exercise, food hoarding, and falsification of dietary intake amounts were more frequently observed in the shoplifting group. Conversely, drug requests and occurrences of self-harm were less frequent in the shoplifting group than in the drug-offense group.
Although these results may be associated with specific characteristics of patients with eating disorders in the medical prison setting, we concluded that the repeated shoplifting by these patients is unrelated to antisocial or impulsive characteristics but is deeply rooted in these patients' severe and undertreated eating disorder psychopathology. Strong supportive treatment should be considered for patients with eating disorders who develop shoplifting behaviors. Further research is required to elucidate the mechanisms responsible for the relationship between shoplifting and eating disorders.
在饮食失调患者中，行窃是一个严重问题。十多年来，我们治疗了许多因反复行窃而被关押在八王子医疗监狱的饮食失调患者。
我们分析了2002年至2011年间转至八王子医疗监狱的女性精神病患者的监狱记录和病历。根据量刑时列出的罪行，我们从所有饮食失调患者中提取了一个行窃组和一个毒品犯罪组。前一组中有一名使用过药物的患者和后一组中两名从未行窃的患者被排除在研究之外。两组分别有41名和14名患者。一个对照组由患有其他精神障碍的患者组成（n = 34）。我们比较了三组患者的饮食失调病史和亚型、体重变化、共病情况、生活史、过去的行为问题和临床行为问题。
与毒品犯罪组和对照组相比，行窃组表现出较少的冲动行为、药物滥用、反社会特征、边缘性人格障碍和过去的贪食症。行窃组的教育程度较高，就业较稳定；然而，他们的饮食失调病史和人际功能障碍更严重，并且他们的精神科治疗退出率更高。行窃组还与低体重、神经性厌食症限制型、强迫行为和强迫型人格障碍存在显著关联。在临床过程中，行窃组中食物拒绝、过度运动、囤积食物和虚报饮食摄入量的情况更为常见。相反，行窃组中药物请求和自我伤害的发生率低于毒品犯罪组。
尽管这些结果可能与医疗监狱环境中饮食失调患者的特定特征有关，但我们得出结论，这些患者的反复行窃与反社会或冲动特征无关，而是深深植根于这些患者严重且未得到充分治疗的饮食失调精神病理学。对于出现行窃行为的饮食失调患者，应考虑给予强有力的支持性治疗。需要进一步研究以阐明行窃与饮食失调之间关系的机制。
