絶食療法後に認知行動療法的アプローチを行い軽快した神経性過食症の1例

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  • A Case of Bulimia Nervosa Improved by Cognitive-Behavioral Approach after Fasting Therapy

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A 27-year-old woman came to our hospital because of binge eating, self-induced vomiting, and loss of self-esteem. Her diagnosis of Bulimia nervosa was made in accordance with DSM-iiiR. When she was administered fasting therapy with Naikan procedure at first, we found out cognitive triad like depressed patients in her cognition, which is negative view of her past, presence, and future. Furthermore we found out she had severe cognitive distortions and she was insufficient to assert herself. Therefore we introduced her psycho-educational approach edited by Katzman et al. from the latter part of fasting period. The purposes of this therapy are as follows ; (1) Eating behaviors are thought as coping behaviors against stressors. Therefore we get patients to make sure of stressful conditions when they write down about their binge eating, selfinduced vomiting, and feelings and thoughts prior to eating. And we also get them to develop their coping skills except for eating behaviors. Then they are tried to correct their thoughts prior to binge and vomiting. (2) Patients modify their problems on their personality and behavior, for example, Iow self-esteem and insufficiency of assertiveness. In our outpatient department, she took self-monitoring used "weekly binge diary". She experienced that she could control her eating behavior because she paid attention to her feelings accompanied with eating behaviors and her cognitive distortions, and she practiced coping behaviors not to binge. In addition, she tried to organize her time by developing to nourish herself as coping behaviors. By the way, she took other cognitive behavioral approaches ; "three columns" and "graded task assignment". Finally, her binge eating and self-induced vomiting diminished after she had developed her sense of control and sense of self-efficacy. After 8 months from beginning of therapy, the Rorschach Test revealed that her emotional and interpersonal aspects improved more than immediately after fasting therapy. Therefore cognitive behavioral approach is effective in this case. We consider that cognitive behavioral approach administered in this case made up for fasting therapy because the followings contributed to maturity of her ego ; (1) similarity to Morita's therapy that gets newer adjustment patterns in the face of reality, (2) patient's experiences of sense of self-efficacy and sense of control in the process of this therapy, (3) modification of cognitive distortions by cognitive interventions and verification of its propriety.

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  • 心身医学

    心身医学 33 (5), 413-418, 1993

    一般社団法人 日本心身医学会

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