Cardi Valentina, Mallorqui-Bague Núria, Albano Gaia, Monteleone Alessio Maria, Fernandez-Aranda Fernando, Treasure Janet
Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain.
Front Psychiatry. 2018 Feb 26;9:12. doi: 10.3389/fpsyt.2018.00012. eCollection 2018.
Anorexia nervosa (AN) is a serious psychiatric disorder characterized by severe restriction of energy intake and dangerously low body weight. Other domains of functioning are affected, including social functioning. Although difficulties within this domain have started to be acknowledged by the literature, some important gaps remain to be filled. Do social difficulties predate the onset of the illness? What difficulties in particular are relevant for the development and maintenance of the illness? The aim of this study is to combine the use of quantitative and qualitative methods to answer these questions. Ninety participants with lifetime AN (88 women and 2 men) completed an online survey assessing memories of involuntary submissiveness within the family, fear of negative evaluation from others, perceived lack of social competence, feelings of social belonging, eating disorder symptoms, and work and social adjustment. Participants also answered three open questions regarding their experience of social relationships before and after the illness onset. The findings provided support for the hypothesized relationships between the study variables. Involuntary submissiveness and fear of negative evaluation predicted eating disorder symptoms and these associations were partially mediated by perceived lack of social competence. Two-thirds of the sample recalled early social difficulties before illness onset and recognized that these had played a role in the development of the illness. A larger proportion of participants stated that the eating disorder had affected their social relationships in a negative way. This study sheds some light on patients' perspective on the predisposing and maintaining role that social difficulties play in AN and identifies key psychological variables that could be targeted in treatment.
神经性厌食症（AN）是一种严重的精神疾病，其特征是能量摄入严重受限和体重极低。其他功能领域也会受到影响，包括社交功能。尽管该领域的困难已开始得到文献的认可，但仍有一些重要空白有待填补。社交困难在疾病发作之前就存在吗？哪些特定困难与该疾病的发展和维持相关？本研究的目的是结合使用定量和定性方法来回答这些问题。90名患有终生神经性厌食症的参与者（88名女性和2名男性）完成了一项在线调查，评估家庭中不自觉顺从的记忆、对他人负面评价的恐惧、感知到的社交能力不足、社会归属感、饮食失调症状以及工作和社会适应情况。参与者还回答了三个关于疾病发作前后社交关系经历的开放性问题。研究结果为研究变量之间的假设关系提供了支持。不自觉顺从和对负面评价的恐惧预测了饮食失调症状，这些关联部分由感知到的社交能力不足介导。三分之二的样本回忆起疾病发作前早期的社交困难，并认识到这些困难在疾病发展中起到了作用。更大比例的参与者表示饮食失调对他们的社交关系产生了负面影响。本研究揭示了患者对社交困难在神经性厌食症中所起的诱发和维持作用的看法，并确定了治疗中可针对的关键心理变量。
