Fallon B A, Sadik C, Saoud J B, Garfinkel R S
New York State Psychiatric Institute, NY 10032.
J Clin Psychiatry. 1994 Oct;55(10):424-8.
About one third of patients with bulimia nervosa continue to do poorly despite intensive treatment. In an effort to identify historical factors that might differentiate patients who are persistently bulimic from patients who have fully recovered, we examined the relationship between long-term outcome and three factors: childhood trauma, family environment, and parental psychopathology.
Fifty-two women previously hospitalized for bulimia nervosa were interviewed 2 to 9 years later. In addition to structured diagnostic interviews, measures included the Family Environment Scale, the Family History interview, and a semistructured interview of childhood abuse. Outcome comparisons were made between the fully recovered and the women who still met DSM-III-R criteria for bulimia nervosa.
Reports of childhood physical abuse and of a family environment characterized by low cohesion and high control were significantly associated with poor outcome. Characteristics of the family environment seemed to have greater influence on outcome than physical abuse alone. Sexual abuse in general was not associated with outcome. Outcome was not associated with comorbidity of Axis I or Axis II disorders or parental psychopathology.
Aspects of the family environment of childhood may contribute to the course of bulimia nervosa. Definitive conclusions require a prospective study.
尽管接受了强化治疗，约三分之一的神经性贪食症患者病情仍持续不佳。为了确定可能区分持续患有贪食症的患者与已完全康复患者的历史因素，我们研究了长期预后与三个因素之间的关系：童年创伤、家庭环境和父母精神病理学。
对52名曾因神经性贪食症住院的女性在2至9年后进行了访谈。除了结构化诊断访谈外，测量方法还包括家庭环境量表、家族史访谈以及童年期虐待的半结构化访谈。对完全康复的女性和仍符合神经性贪食症DSM-III-R标准的女性的预后进行了比较。
童年期身体虐待的报告以及以低凝聚力和高控制为特征的家庭环境与不良预后显著相关。家庭环境的特征似乎比单纯的身体虐待对预后的影响更大。一般来说，性虐待与预后无关。预后与轴I或轴II障碍的共病或父母精神病理学无关。
童年家庭环境的某些方面可能会影响神经性贪食症的病程。确切结论需要前瞻性研究。
