Garfinkel P E, Moldofsky H, Garner D M
Can Med Assoc J. 1977 Nov 5;117(9):1041-5.
The use of behaviour modification in the treatment of anorexia nervosa has been controversial and has not undergone controlled studies. An investigation of 42 patients with anorexia nervosa treated a mean of 31.7 months earlier was conducted to determine factors related to prognosis. The three areas studied were (a) clinical features, (b) treatment (behaviour modification versus medical and psychologic therapy) and (c) self-perception (with a distorting photographic technique). Clinical outcome was assessed as "excellent" in 7, "much improved" in 14, "symptomatic" in 13 and "poor" In 8. Analysis of variance showed that vomiting (P less than 0.01), bulimia (P less than 0.01), poor educational/vocational adjustment (P less than 0.01) and higher global clinical score (P less than 0.001) were associated with a poor prognosis. There were no differences at follow-up between patients treated by behaviour modification and those treated by other methods; the data suggest that behaviour modification, while not harmful, does not provide long-term benefits. Self-estimates of body size were highly predictive of outcome (P less than 0.002); all patients with a poor outcome overestimated their size. Patients with only marginal improvement might be helped by treatment directed to self-perceptual disturbances.
在神经性厌食症治疗中使用行为矫正一直存在争议，且尚未经过对照研究。对42例平均在31.7个月前接受治疗的神经性厌食症患者进行了一项调查，以确定与预后相关的因素。研究的三个方面是：(a)临床特征；(b)治疗（行为矫正与医学及心理治疗）；(c)自我认知（采用一种变形摄影技术）。临床结果评估为“优秀”的有7例，“明显改善”的有14例，“有症状”的有13例，“差”的有8例。方差分析表明，呕吐（P<0.01）、贪食（P<0.01）、教育/职业适应不良（P<0.01）和较高的总体临床评分（P<0.001）与预后不良相关。行为矫正治疗的患者与其他方法治疗的患者在随访时没有差异；数据表明，行为矫正虽无害，但不能带来长期益处。身体大小的自我估计对结果具有高度预测性（P<0.002）；所有预后不良的患者都高估了自己的体型。对自我感知障碍进行针对性治疗可能有助于仅有轻微改善的患者。
