Hamagaki S
Department of Psychiatry, School of Medicine, Kyoto University.
Seishin Shinkeigaku Zasshi. 1995;97(1):1-30.
Binge-eating is one of the most paradoxical phenomena in the symptomatology of anorexia nervosa and bulimia nervosa. The patients seem to be struggling to control their eating behaviors as strictly as possible, and at the same time, they repeat chaotic patterns of binge-eating. The author investigated the descriptive psychopathology of binge-eating in this paper. The author recognized the impulsive nature of binge-eating at first, and compared it with the clinical features of so-called impulse control disorders, such as kleptomania, trichotillomania, and so on. According to the literature review, most impulse control disorders tended to show high coincidence with eating disorders. The mode of the coincidence and the alternation of the symptoms suggested the common psychopathologies between eating disorders and impulse control disorders. The author then inquired into their common psychopathologies, and revealed characteristic features which could be formulated as dissociative. The study of the concept of dissociation proved that this formulation was not only valid, but also useful in understanding eating disorders clinically and theoretically. Binge-eating could be regarded as a manifestation of dissociative pathology. The author inquired further into the psychopathologies of eating disorders and impulse control disorders, and revealed obsessional features in these disorders. Though some investigators regarded the symptoms of eating disorders as compulsive behaviors and considered that eating disorders were variants of obsessive-compulsive disorder, the author pointed out some descriptive differences between them. Nevertheless, the obsessionality formed an important basis of the psychopathology of binge-eating. Finally, the author discussed the relationship between the obsessionality and the dissociativity in eating disorders. These two features were reciprocal factors in mental activity, and were forming dialectical dynamism in general psychological functioning. In anorexia nervosa and bulimia nervosa, the opposition between two factors was morbidly rigid and their sublation could not occur. Though the obsessional and the dissociative features of binge-eating were opposite phenomena, it was important to comprehend them as an incorporated psychopathology. The conceptualization of the dialectic of the obsessionality and the dissociativity could also be useful in understanding other psychopathological phenomena such as addiction and splitting.
暴饮暴食是神经性厌食症和神经性贪食症症状学中最矛盾的现象之一。患者似乎在竭力严格控制自己的饮食行为，与此同时，他们却反复出现暴饮暴食的混乱模式。本文作者对暴饮暴食的描述性精神病理学进行了研究。作者首先认识到暴饮暴食的冲动本质，并将其与诸如盗窃癖、拔毛癖等所谓冲动控制障碍的临床特征进行了比较。根据文献综述，大多数冲动控制障碍往往与饮食失调高度重合。这种重合模式以及症状的交替表明了饮食失调和冲动控制障碍之间存在共同的精神病理学特征。作者随后探究了它们的共同精神病理学特征，并揭示了可被归纳为分离性的特征。对分离概念的研究证明，这种归纳不仅有效，而且在临床和理论上理解饮食失调方面也很有用。暴饮暴食可被视为分离性病理的一种表现。作者进一步探究了饮食失调和冲动控制障碍的精神病理学特征，并揭示了这些障碍中的强迫观念特征。尽管一些研究者将饮食失调的症状视为强迫行为，并认为饮食失调是强迫症的变体，但作者指出了它们之间在描述上的一些差异。然而，强迫观念构成了暴饮暴食精神病理学的一个重要基础。最后，作者讨论了饮食失调中强迫观念与分离性之间的关系。这两个特征是心理活动中的相互因素，在一般心理功能中形成辩证动态。在神经性厌食症和神经性贪食症中，这两个因素之间的对立病态地僵化，无法发生扬弃。尽管暴饮暴食的强迫观念和分离性特征是相反的现象，但将它们理解为一种综合的精神病理学很重要。强迫观念与分离性的辩证法概念化在理解诸如成瘾和分裂等其他精神病理现象方面也可能有用。
