Noma Shun'ichi, Uwatoko Teruhisa, Ono Miki, Miyagi Takashi, Murai Toshiya
NOMA, ONO, and MURAI: Department of Psychiatry, Graduate School of Medicine, Kyoto University UWATOKO: Kyoto University Health Service, Kyoto MIYAGI: Department of Psychiatry, Toyooka Hospital, Hyogo, Japan.
J Psychiatr Pract. 2015 May;21(3):198-207. doi: 10.1097/PRA.0000000000000067.
Although it has been reported that 25% to 50% of patients with eating disorders engage in self-harming behaviors (SHBs), including nonsuicidal self-injury (NSSI) and suicidal behavior (SB), no study has investigated the psychological mechanisms underlying these SHBs or any differences that may exist between NSSI and SB. This study involved 76 female patients with eating disorders who were treated at the Kyoto University Hospital between July and August, 2010, who answered questionnaires about SHBs, eating attitudes, tendency to dissociate, and attachment style. Some of the participants (22.4%) had other psychiatric disorders in addition to eating disorders, including borderline personality disorder, dissociative disorder, and posttraumatic stress disorder. Of the participants without comorbidity, 23.7% had engaged in SHBs in the past 3 months. Participants with comorbidity tended to dissociate significantly more than participants without comorbidity. Logistic regression indicated that, in all participants, NSSI in the past 3 months was related to the tendency to dissociate and having a higher body mass index, whereas preoccupied attachment style was potentially related to recent SB. Specifically, among the participants without comorbidity, a sense of ineffectiveness and poor interoceptive awareness were related to recent NSSI, and severity of binge-eating was related to SB. In contrast, a history of NSSI in the patients with eating disorders without comorbidity was related to a sense of ineffectiveness. The results of our study suggest that it may be important to help patients with eating disorders recover their own sense of effectiveness as a possible way to reduce SHBs.
尽管有报道称，25%至50%的饮食失调患者会出现自我伤害行为（SHBs），包括非自杀性自伤（NSSI）和自杀行为（SB），但尚无研究调查这些自我伤害行为背后的心理机制，或NSSI与SB之间可能存在的任何差异。本研究纳入了2010年7月至8月在京都大学医院接受治疗的76名女性饮食失调患者，她们回答了关于自我伤害行为、饮食态度、解离倾向和依恋风格的问卷。一些参与者（22.4%）除饮食失调外还患有其他精神疾病，包括边缘性人格障碍、解离性障碍和创伤后应激障碍。在无合并症的参与者中，23.7%在过去3个月内有过自我伤害行为。有合并症的参与者比无合并症的参与者更容易出现解离。逻辑回归分析表明，在所有参与者中，过去3个月内的NSSI与解离倾向和较高的体重指数有关，而过度关注的依恋风格可能与近期的SB有关。具体而言，在无合并症的参与者中，无效感和较差的内感受性觉知与近期的NSSI有关，暴饮暴食的严重程度与SB有关。相比之下，无合并症的饮食失调患者的NSSI史与无效感有关。我们的研究结果表明，帮助饮食失调患者恢复自身的效能感，可能是减少自我伤害行为的一种重要方式。
