Kuipers Greet S, Hollander Sandra den, van der Ark L Andries, Bekker Marrie H J
Unit for Eating Disorders, GGZ Breburg, PO Box 770, 5000 AT, Tilburg, The Netherlands.
Den Hollander Van den Broek, Piacenzastraat 19, 5262 EN, Vught, The Netherlands.
Eat Weight Disord. 2017 Sep;22(3):535-547. doi: 10.1007/s40519-017-0405-x. Epub 2017 Jun 22.
To investigate whether recovery from an eating disorder is related to pre-treatment attachment and mentalization and/or to improvement of attachment and mentalization during treatment.
For a sample of 38 anorexia nervosa (AN) and bulimia nervosa (BN) patients receiving treatment the relations between attachment security, mentalization, comorbidity and recovery status after 12 months (not recovered or recovered), and after 18 months (persistently ill, relapsed, newly recovered, or persistently recovered) were investigated. Attachment security and mentalization were assessed by the Adult Attachment Interview at the start of the treatment and after 12 months. Besides assessing co-morbidity-for its effect on treatment outcome-we measured psycho-neuroticism and autonomy because of their established relations to both eating disorder symptoms and to attachment security.
Recovery both at 12 months and at 18 months was related to higher levels of mentalization; for attachment, no significant differences were found between recovered and unrecovered patients. Patients who recovered from AN or BN also improved on co-morbid symptoms: whereas pre-treatment symptom severity was similar, at 12 months recovered patients scored lower on co-morbid personality disorders, anxiety, depression, self-injurious behaviour and psycho-neuroticism than unrecovered patients. Improvement on autonomy (reduced sensitivity to others; greater capacity to manage new situations) in 1 year of treatment was significantly higher in recovered than in unrecovered patients.
A focus on enhancing mentalization in eating disorder treatment might be useful to increase the chances of successful treatment. Improvement of autonomy might be the mechanism of change in recovering from AN or BN.
Level III cohort study.
研究饮食失调的康复是否与治疗前的依恋和心理化，和/或治疗期间依恋和心理化的改善有关。
对38名接受治疗的神经性厌食症（AN）和神经性贪食症（BN）患者的样本，调查了治疗12个月后（未康复或康复）以及18个月后（持续患病、复发、新康复或持续康复）依恋安全性、心理化、共病与康复状态之间的关系。在治疗开始时和12个月后，通过成人依恋访谈评估依恋安全性和心理化。除了评估共病对治疗结果的影响外，我们还测量了精神神经质和自主性，因为它们与饮食失调症状和依恋安全性都有关系。
12个月和18个月时的康复都与较高水平的心理化有关；对于依恋，康复患者和未康复患者之间未发现显著差异。从AN或BN中康复的患者在共病症状方面也有所改善：虽然治疗前症状严重程度相似，但在12个月时，康复患者在共病性人格障碍、焦虑、抑郁、自伤行为和精神神经质方面的得分低于未康复患者。在1年的治疗中，康复患者的自主性改善（对他人的敏感度降低；处理新情况的能力增强）明显高于未康复患者。
在饮食失调治疗中关注增强心理化可能有助于提高成功治疗的几率。自主性的改善可能是从AN或BN中康复的改变机制。
III级队列研究。
