Wilson C P, Mintz I
Prim Care. 1982 Sep;9(3):517-30.
This article presents a psychodynamic approach to the understanding and treatment of abstaining and bulemic anorexics. While the abstainer starves herself to the point of emaciation and the bulemic may gorge to the point of obesity, the underlying emotional conflicts of the two groups of patients are the same. The ego (character structure) of the bulemic is not as perfectionistic and rigid as that of the abstainer, so the patient is periodically overwhelmed not only by impulses to gorge but also by impulses of all kinds. A description of the clinical syndrome, the physiological findings and details of the laboratory diagnosis of anorexia nervosa are provided. Family psychodynamics which are viewed as etiologic are presented. A psychodynamic therapeutic approach is described and examples of the treatment of an abstaining and bulemic patient are detailed. The crucial therapeutic role of the family physician is explored with emphasis on the importance of the physician's encouraging the patient to bring up questions about food and eating with the psychiatrist because such preoccupations mask other conflicts.
本文提出了一种理解和治疗禁食型和暴食型神经性厌食症患者的心理动力学方法。虽然禁食型患者会将自己饿到消瘦，而暴食型患者可能会吃到肥胖，但这两组患者潜在的情感冲突是相同的。暴食型患者的自我（性格结构）不像禁食型患者那样完美主义和刻板，所以这类患者不仅会周期性地被暴食冲动所困扰，还会被各种冲动所左右。文中提供了神经性厌食症的临床综合征、生理检查结果及实验室诊断细节的描述。还介绍了被视为病因的家庭心理动力学。描述了一种心理动力学治疗方法，并详细列举了一名禁食型和暴食型患者的治疗案例。探讨了家庭医生在治疗中的关键作用，强调医生鼓励患者向精神科医生提出有关食物和饮食问题的重要性，因为这些关注点掩盖了其他冲突。
