Raykos Bronwyn C, McEvoy Peter M, Fursland Anthea
Centre for Clinical Interventions, Perth, Australia.
School of Psychology and Speech Pathology, Curtin University, Perth, Australia.
Int J Eat Disord. 2017 Sep;50(9):1075-1083. doi: 10.1002/eat.22740. Epub 2017 Jun 26.
The present study evaluated the relative clinical validity of two interpersonal models of the maintenance of eating disorders, IPT-ED (Rieger et al., ) and the interpersonal model of binge eating (Wilfley, MacKenzie, Welch, Ayres, & Weissman, ; Wilfley, Pike, & Striegel-Moore, ). While both models propose an indirect relationship between interpersonal problems and eating disorder symptoms via negative affect, IPT-ED specifies negative social evaluation as the key interpersonal problem, and places greater emphasis on the role of low self-esteem as an intermediate variable between negative social evaluation and eating pathology.
Treatment-seeking individuals (N = 306) with a diagnosed eating disorder completed measures of socializing problems, generic interpersonal problems, self-esteem, eating disorder symptoms, and negative affect (depression and anxiety). Structural equation models were run for both models.
Consistent with IPT-ED, a significant indirect pathway was found from socializing problems to eating disorder symptoms via low self-esteem and anxiety symptoms. There was also a direct pathway from low self-esteem to eating disorder symptoms. Using a socializing problems factor in the model resulted in a significantly better fit than a generic interpersonal problems factor. Inconsistent with both interpersonal models, the direct pathway from socializing problems to eating disorder symptoms was not supported.
Interpersonal models that included self-esteem and focused on socializing problems (rather than generic interpersonal problems) explained more variance in eating disorder symptoms. Future experimental, prospective, and treatment studies are required to strengthen the case that these pathways are causal.
本研究评估了两种饮食失调维持人际模型的相对临床效度，即进食障碍人际关系治疗模型（IPT-ED，里格尔等人）和暴饮暴食人际模型（威尔夫利、麦肯齐、韦尔奇、艾尔斯和魏斯曼；威尔夫利、派克和斯特里格尔-摩尔）。虽然这两种模型都提出人际问题与饮食失调症状之间通过消极情绪存在间接关系，但IPT-ED将负面社会评价确定为关键人际问题，并更加强调低自尊作为负面社会评价与饮食病理学之间中间变量的作用。
寻求治疗的306名被诊断患有饮食失调的个体完成了社交问题、一般人际问题、自尊、饮食失调症状和消极情绪（抑郁和焦虑）的测量。对两种模型都进行了结构方程模型分析。
与IPT-ED一致，发现了一条从社交问题通过低自尊和焦虑症状到饮食失调症状的显著间接路径。也有一条从低自尊到饮食失调症状的直接路径。在模型中使用社交问题因素比使用一般人际问题因素的拟合度显著更好。与两种人际模型均不一致的是，未支持从社交问题到饮食失调症状的直接路径。
包含自尊并聚焦于社交问题（而非一般人际问题）的人际模型能解释饮食失调症状中更多的变异。未来需要进行实验性、前瞻性和治疗性研究，以强化这些路径具有因果关系的论据。
