典型和非典型神经性厌食症中的功能失调性元认知和对苗条的渴望。
Dysfunctional metacognition and drive for thinness in typical and atypical anorexia nervosa.
机构信息
Melbourne School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Redmond Barry Building, Victoria, 3010 Australia ; The Eating Disorders Unit, Royal Melbourne Hospital, Melbourne, Australia.
Melbourne School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Redmond Barry Building, Victoria, 3010 Australia.
出版信息
J Eat Disord. 2015 Jul 4;3:24. doi: 10.1186/s40337-015-0060-4. eCollection 2015.
BACKGROUND
Anorexia nervosa is complex and difficult to treat. In cognitive therapies the focus has been on cognitive content rather than process. Process-oriented therapies may modify the higher level cognitive processes of metacognition, reported as dysfunctional in adult anorexia nervosa. Their association with clinical features of anorexia nervosa, however, is unclear. With reclassification of anorexia nervosa by DSM-5 into typical and atypical groups, comparability of metacognition and drive for thinness across groups and relationships within groups is also unclear. Main objectives were to determine whether metacognitive factors differ across typical and atypical anorexia nervosa and a non-clinical community sample, and to explore a process model by determining whether drive for thinness is concurrently predicted by metacognitive factors.
METHODS
Women receiving treatment for anorexia nervosa (n = 119) and non-clinical community participants (n = 100), aged between 18 and 46 years, completed the Eating Disorders Inventory (3(rd) Edition) and Metacognitions Questionnaire (Brief Version). Body Mass Index (BMI) of 18.5 kg/m(2) differentiated between typical (n = 75) and atypical (n = 44) anorexia nervosa. Multivariate analyses of variance and regression analyses were conducted.
RESULTS
Metacognitive profiles were similar in both typical and atypical anorexia nervosa and confirmed as more dysfunctional than in the non-clinical group. Drive for thinness was concurrently predicted in the typical patients by the metacognitive factors, positive beliefs about worry, and need to control thoughts; in the atypical patients by negative beliefs about worry and, inversely, by cognitive self-consciousness, and in the non-clinical group by cognitive self-consciousness.
CONCLUSIONS
Despite having a healthier weight, the atypical group was as severely affected by dysfunctional metacognitions and drive for thinness as the typical group. Because metacognition concurrently predicted drive for thinness in both groups, a role for process-oriented therapy in adults is suggested. Implications are discussed.
背景
神经性厌食症较为复杂，且难以治疗。在认知疗法中，重点一直放在认知内容上，而非认知过程。面向过程的治疗方法可能会改变元认知等高级认知过程，这些过程在成年神经性厌食症中被报告为功能失调。然而，它们与神经性厌食症的临床特征之间的关系尚不清楚。由于 DSM-5 将神经性厌食症重新分类为典型和非典型组，因此，两组之间以及组内的元认知和对消瘦的渴望是否具有可比性尚不清楚。主要目的是确定元认知因素是否在典型和非典型神经性厌食症以及非临床社区样本中存在差异，并通过确定对消瘦的渴望是否同时受到元认知因素的预测来探索一个过程模型。
方法
接受神经性厌食症治疗的女性（n=119）和非临床社区参与者（n=100），年龄在 18 至 46 岁之间，完成了饮食障碍问卷（第 3 版）和元认知问卷（简短版）。BMI（体重指数）为 18.5kg/m² 将典型组（n=75）和非典型组（n=44）区分开来。进行了多元方差分析和回归分析。
结果
典型和非典型神经性厌食症患者的元认知模式相似，并证实比非临床组更为功能失调。在典型患者中，对消瘦的渴望同时受到元认知因素、对担忧的积极信念和控制思维的需要的预测；在非典型患者中，受到担忧的消极信念以及相反的，受到认知自我意识的预测；在非临床组中，则受到认知自我意识的预测。
结论
尽管非典型组的体重更健康，但他们受到功能失调的元认知和对消瘦的渴望的影响与典型组一样严重。由于元认知同时预测了两组对消瘦的渴望，因此建议在成人中使用面向过程的治疗方法。讨论了其影响。
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