Gutiérrez Emilio, Carrera Olaia
Department of Clinical Psychology and Psychobiology, College of Psychology, University of Santiago, Santiago de Compostela, Spain.
Venres Clínicos Unit, College of Psychology, University of Santiago, Santiago de Compostela, Spain.
Front Psychiatry. 2021 Feb 15;11:538997. doi: 10.3389/fpsyt.2020.538997. eCollection 2020.
To the extent that severe and lasting anorexia nervosa (SE-AN) is defined in terms of refractoriness to the best treatments available, it is mandatory to scrutinize the proven effectiveness of the treatments offered to patients. The array of so-called current evidence-based treatments for anorexia nervosa (AN) encompasses the entire spectrum of treatments ranging from specialized brand-type treatments to new treatments adapted to the specific characteristics of people suffering from AN. However, after several randomized control trials, parity in efficacy is the characteristic among these treatments. To further complicate the landscape of effective treatments, this "tie score" extends to the treatment originally conceived as control conditions, or treatment as usual conditions. In retrospection, one can understand that treatments considered to be the best treatments available in the past were unaware of their possible iatrogenic effects. Obviously, the same can be said of the theoretical assumptions underpinning such treatments. In either case, if the definition of chronicity mentioned above is applied, it is clear that the responsibility for the chronicity of the disorder says more about the flagrant inefficacy of the treatments and the defective assumptions underpinning them, than the nature of the disorder itself. A historical analysis traces the emergence of the current concept of "typical" AN and Hilde Bruch's contribution to it. It is concluded that today's diagnostic criteria resulting from a long process of acculturation distort rather than capture the essence of the disorder, as well as marginalizing and invalidating patients' perspectives.
就严重且持久的神经性厌食症（SE - AN）是根据对现有最佳治疗方法的难治性来定义而言，审视提供给患者的治疗方法已证实的有效性是必不可少的。一系列所谓当前基于证据的神经性厌食症（AN）治疗方法涵盖了从专门的品牌型治疗到适应神经性厌食症患者特定特征的新治疗方法的整个治疗范围。然而，经过几次随机对照试验后，这些治疗方法的疗效相当。为有效治疗的局面进一步复杂化的是，这种“平局比分”延伸到了最初被视为对照条件或常规治疗条件的治疗方法。回顾过去，可以理解过去被认为是现有最佳治疗方法的治疗并未意识到其可能的医源性影响。显然，支撑此类治疗的理论假设也是如此。在任何一种情况下，如果应用上述慢性化的定义，很明显，该疾病慢性化的责任更多地在于治疗方法的公然无效以及支撑它们的有缺陷的假设，而非疾病本身的性质。一项历史分析追溯了当前“典型”AN概念的出现以及希尔德·布鲁赫对此的贡献。得出的结论是，经过长期文化适应过程产生的当今诊断标准歪曲而非抓住了该疾病的本质，同时也将患者的观点边缘化并使其无效。
