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采用焦虑障碍框架概念化进食障碍病理:基于暴露的临床研究的证据和意义。

Conceptualizing eating disorder psychopathology using an anxiety disorders framework: Evidence and implications for exposure-based clinical research.

机构信息

University of Wisconsin, Madison, United States of America.

Hofstra University, United States of America.

出版信息

Clin Psychol Rev. 2021 Feb;83:101952. doi: 10.1016/j.cpr.2020.101952. Epub 2020 Nov 11.

Abstract

Eating disorders (EDs) and anxiety disorders (ADs) evidence shared risk and significant comorbidity. Recent advances in understanding of anxiety-based disorders may have direct application to research and treatment efforts for EDs. The current review presents an up-to-date, behavioral conceptualization of the overlap between anxiety-based disorders and EDs. We identify ways in which anxiety presents in EDs, consider differences between EDs and ADs relevant to treatment adaptions, discuss how exposure-based strategies may be adapted for use in ED treatment, and outline directions for future mechanistic, translational, and clinical ED research from this perspective. Important research directions include: simultaneous examination of the extent to which EDs are characterized by aberrant avoidance-, reward-, and/or habit-based neurobiological and behavioral processes; improvement in understanding of how nutritional status interacts with neurobiological characteristics of EDs; incorporation of a growing knowledge of biobehavioral signatures in ED treatment planning; development of more comprehensive exposure-based treatment approaches for EDs; testing whether certain exposure interventions for AD are appropriate for EDs; and improvement in clinician self-efficacy and ability to use exposure therapy for EDs.

摘要

进食障碍(EDs)和焦虑障碍(ADs)存在共同的风险和显著的共病。目前对基于焦虑障碍的理解的进展可能直接应用于 EDs 的研究和治疗工作。目前的综述提出了一种基于行为的最新概念,阐述了基于焦虑障碍和 EDs 之间的重叠。我们确定了焦虑在 EDs 中的表现方式,考虑了 EDs 和 ADs 之间与治疗适应相关的差异,讨论了如何调整基于暴露的策略以用于 ED 治疗,并从这个角度概述了未来 ED 研究的机制、转化和临床方向。重要的研究方向包括:同时检查 ED 是否以异常回避、奖励和/或基于习惯的神经生物学和行为过程为特征的程度;更好地理解营养状况如何与 ED 的神经生物学特征相互作用;将 ED 治疗计划中的日益增长的生物行为特征知识纳入其中;开发更全面的基于暴露的 ED 治疗方法;测试 AD 的某些暴露干预措施是否适合 EDs;提高临床医生使用暴露疗法治疗 ED 的自我效能和能力。

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