Tomizawa O
Department of Psychiatry, Tokyo Medical College.
Seishin Shinkeigaku Zasshi. 1995;97(5):326-56.
The various psychotherapeutic strategies for eating disorders (EDs) include psychoanalytic, cognitive-behavioral, family oriented, arts therapy and others. In this paper, the psychodynamism of EDs and their therapy are reexamined and considered holistically from "the separate aspects of eating" point of view. That is the separation of eating regulated by biological appetite and the eating or not eating deriving from the patient's mind, unrelated to appetite. A new therapeutic technique called "formalization", which clarifies the separation of aspects of eating are invented. For integrated psychotherapy of EDs, it is necessary to combine the formalization technique of which clarifies and promotes patients' conflicts, and the integrated psychodynamic therapies that treat the promoted conflicts. The psychodynamism of EDs is the subject of much argument by many therapist. Although these arguments differ, they are similar in two points. Firstly, all of them consider EDs as distinctly separate from biological appetites. Secondly, the behavior of patients with EDs are taken as "false solution" or "substitution" of their essential problem. It is impossible to completely separate the physical action of eating mentally, however there may be a second meaning of eating separate from appetite. Seen in this light, psychotherapies are classified into two groups. One supports and sympathizes with these conflicts and the other is an educational one, telling the patients that a false solution is invalid. The former approach is employed by almost all psychodynamic therapies, such as psychoanalysis, family oriented therapy, arts therapy, self-help groups and the like. These therapies treat patients' conflicts with a non-judgemental approach, transform the psychodynamism, and consequently improve the eating behavior. The latter is applied by behavior therapy. Under strict operant conditioning, adequate behavior is reinforced by reward and inadequate behavior is eliminated by punishment. This way aims to transform the behavior first, change the cognition, and turn off the conflicts. In this sense the eating behavior and its psychological meaning are rated by a fixed value system. It is therefore important to integrate the strong points of these therapies. In other words, the therapeutic approach must be effective in improving behavior, maintaining good therapeutic relationships, radically transforming their psychodynamism. Formalization is a process of clarification of the separate aspects of eating in cases of EDs. At the beginning of treatment it is essential to clarify the double meaning of symptoms. Psychodynamically, there must be a "good" meaning in ED and it is necessary to be appraised.(ABSTRACT TRUNCATED AT 400 WORDS)
针对饮食失调症（EDs）的各种心理治疗策略包括精神分析、认知行为、家庭导向、艺术治疗等。本文从“饮食的不同方面”的角度，对饮食失调症的心理动力学及其治疗进行了重新审视和整体考量。也就是说，将受生物性食欲调节的饮食与源自患者心理、与食欲无关的进食或不进食区分开来。一种名为“形式化”的新治疗技术被发明出来，它能阐明饮食各方面的分离。对于饮食失调症的综合心理治疗，有必要将能阐明并促进患者冲突的形式化技术与治疗所引发冲突的综合心理动力疗法相结合。饮食失调症的心理动力学是许多治疗师争论的焦点。尽管这些争论各不相同，但在两点上是相似的。首先，他们都认为饮食失调症与生物性食欲明显不同。其次，饮食失调症患者的行为被视为其本质问题的“错误解决方案”或“替代方式”。然而，在心理层面上完全将进食的身体行为区分开来是不可能的，不过可能存在一种与食欲无关的进食的第二层含义。从这个角度看，心理治疗可分为两类。一类支持并同情这些冲突，另一类是教育性的，告知患者错误的解决方案是无效的。前一种方法几乎被所有心理动力疗法采用，如精神分析、家庭导向疗法、艺术治疗、自助团体等。这些疗法以非评判的方式处理患者的冲突，转变心理动力学，从而改善进食行为。后一种方法由行为疗法应用。在严格的操作性条件作用下，适当的行为通过奖励得到强化，不适当的行为通过惩罚被消除。这种方法旨在首先改变行为，改变认知，消除冲突。从这个意义上说，进食行为及其心理意义是通过一个固定的价值体系来评判的。因此，整合这些疗法的优点很重要。换句话说，治疗方法必须在改善行为、维持良好的治疗关系以及从根本上转变其心理动力学方面有效。形式化是在饮食失调症病例中阐明饮食不同方面的过程。在治疗开始时，明确症状的双重含义至关重要。从心理动力学角度看，饮食失调症中必然存在一种“好”的含义，有必要进行评估。（摘要截断于400字）
