是无法停止还是不想停止?节食作为神经性厌食症或非典型神经性厌食症患者的一种习惯行为。
Won't stop or can't stop? Food restriction as a habitual behavior among individuals with anorexia nervosa or atypical anorexia nervosa.
作者信息
Coniglio Kathryn A, Becker Kendra R, Franko Debra L, Zayas Lazaro V, Plessow Franziska, Eddy Kamryn T, Thomas Jennifer J
机构信息
Eating Disorders Clinical and Research Program, Massachusetts General Hospital, United States.
Eating Disorders Clinical and Research Program, Massachusetts General Hospital, United States; Department of Psychiatry, Harvard Medical School, United States.
出版信息
Eat Behav. 2017 Aug;26:144-147. doi: 10.1016/j.eatbeh.2017.03.005. Epub 2017 Mar 22.
Food restriction among individuals with anorexia nervosa (AN) is regarded as a goal-directed behavior. However, Walsh (2013) theorized that, although restriction is initially maintained by operant conditioning (with successful weight loss and external praise as salient rewards), it ultimately becomes a classically conditioned habit, persisting regardless of the presence of these once-salient rewards. Understanding food restriction as a well-ingrained habit may provide insight into treatment resistance. Further, it is not clear whether habitual food restriction is present among individuals with atypical AN (i.e. who engage in food restriction but are not low-weight). This study evaluated whether strength of habit predicted self-reported restriction above and beyond cognitive restraint. Seventy-eight individuals with AN or atypical AN completed the Eating Pathology Symptoms Inventory Restriction (EPSI-R) and Cognitive Restraint (EPSI-CR) subscales and the Self-Report Habit Index (SRHI) adapted for food restriction. We used a hierarchical multiple regression model to test whether habit strength predicted food restriction above and beyond cognitive restraint. After adding illness duration (step 1) and diagnosis (step 2) to the model, cognitive restraint (step 3) was not significant in explaining variation in restriction, whereas adding habit strength to the model (step 4) explained 27.9% of the variance in restriction (p<0.001). This is the first study to test a key component of Walsh's theory. Results provide support for food restriction maintenance through habit, rather than through effortful cognitive restraint. Because current models of AN characterize food restriction as purposeful, further research is needed to better understand habitual restriction in AN.
神经性厌食症(AN)患者的食物限制被视为一种目标导向行为。然而,沃尔什(2013年)提出理论认为,尽管食物限制最初是通过操作性条件反射维持的(成功减重和外界赞扬是显著的奖励),但它最终会变成一种经典条件反射的习惯,无论这些曾经显著的奖励是否存在都会持续存在。将食物限制理解为一种根深蒂固的习惯可能有助于深入了解治疗抵抗。此外,目前尚不清楚非典型AN患者(即那些进行食物限制但体重并不低的人)是否存在习惯性食物限制。本研究评估了习惯强度是否能预测自我报告的食物限制,且超出认知抑制的影响。78名患有AN或非典型AN的个体完成了饮食病理症状量表限制分量表(EPSI-R)、认知抑制分量表(EPSI-CR)以及针对食物限制改编的自我报告习惯指数(SRHI)。我们使用分层多元回归模型来检验习惯强度是否能预测超出认知抑制的食物限制。在模型中加入病程(第1步)和诊断(第2步)后,认知抑制(第3步)在解释限制的变化方面并不显著,而在模型中加入习惯强度(第4步)后,解释了限制方差的27.9%(p<0.001)。这是第一项检验沃尔什理论关键组成部分的研究。研究结果支持食物限制是通过习惯维持的,而非通过刻意的认知抑制。由于目前AN的模型将食物限制描述为有目的的,因此需要进一步研究以更好地理解AN中的习惯性限制。