Davis J da R, Crisp A H
Department of Mental Health Sciences, St George's Hospital Medical School, London, UK.
Br J Med Psychol. 1993 Mar;66(1):79-87. doi: 10.1111/j.2044-8341.1993.tb01729.x.
The nature of the relationship between accidental trauma and psychopathology may not always be clear. Cases of post-traumatic anorexia nervosa have been described but without detailed attention to pre-existing psychopathological processes. This may give rise to spurious conclusions about direction of casualty. We describe a male patient who developed anorexia nervosa on two occasions, both episodes occurring during the convalescent period following traumatic accidents several years apart. The intervening period was characterized by strict self-regulation and conflict avoidance, typical of anorexia nervosa but with the body maintained at only a moderately low weight. We suggest that accidents can arise at times of crisis in such ongoing attempts at intense self-regulation. They may then reflect the escape from control of impulsivity and also provide an ultimate means of avoidance of further guilt-laden behaviour. They can be understood in the light of pre-existing psychopathology. The difficulties in early recognition and diagnosis of anorexia nervosa, especially in the male and in the absence of extreme weight loss are also discussed.
意外创伤与精神病理学之间的关系本质可能并不总是清晰的。创伤后神经性厌食症的病例已有描述，但未详细关注先前存在的精神病理过程。这可能会导致关于因果关系方向的错误结论。我们描述了一名男性患者，他曾两次患上神经性厌食症，两次发作均发生在相隔数年的创伤性事故后的康复期。中间期的特点是严格的自我调节和冲突回避，这是神经性厌食症的典型表现，但体重仅维持在适度偏低的水平。我们认为，在这种持续的强烈自我调节尝试的危机时刻可能会发生事故。它们可能反映出从冲动控制中逃脱，也提供了一种避免进一步有罪行为的最终手段。可以根据先前存在的精神病理学来理解它们。文中还讨论了早期识别和诊断神经性厌食症的困难，尤其是在男性患者以及没有极度体重减轻的情况下。
