大量の下剤乱用を長期にわたって続けた神経性食欲不振症の1改善例 : 行動制限を用いた認知行動療法による入院治療過程を中心に  [in Japanese] A Patient with Prolonged Anorexia Nervosa and Long Term Laxative Abuse was Successfully Treated with Cognitive-Behavioral Therapy that Included Behavioral Limitation  [in Japanese]

大量の下剤乱用を10年間にわたり続けていた神経性食欲不振症の遷延例である.このような症例は難治であり予後も不良とされるが,当科で行っている,「行動制限を用いた認知行動療法」が奏効し,退院後3年半経っても順調に推移しているので,報告する.「行動制限を用いた認知行動療法」では,患者が肥満恐怖に向き合い,体重増加を図っていくと同時に,行動制限中に表出してきた患者の問題行動を適宜扱う.本患者は,入院治療の過程で,現実生活でいやなことから逃げるという「葛藤回避」が自分の本質的な問題であることを認めるようになった.その結果,「葛藤」から逃げることなく,実際に体重を増やすことができ,体重のみならず家族や対人関係における認知や行動に変化がみられるようになった.本稿では,治療を通じて,患者の認知や行動が変化していった経緯と治療上の留意点について述べた.

This case report is of a female patient with prolonged anorexia nervosa who used a great deal of laxatives over a ten year period. Although the disease was intractable and the prognosis was poor, "cognitive behavioral therapy with behavioral limitation" was proved to be effective and the course after discharge was satisfactory. In "cognitive-behavioral therapy with behavioral limitation", the patients attempt to increase their weight and to confront their fears of gaining weight. At the same time, the problematic behaviors that come out during behavioral limitation are treated in a timely manner. This patient came to realize that the essential problem that needed to be solved was 'conflict evasion' ; avoidance of unpleasant things encountered in her life. As a result, her weight gained steadily as she learned not to escape from conflict. Moreover, the change was reflected in her cognition and behavior in relation to her family and interpersonal relationships. In this report, we show the process of change through treatment in both the cognition and the behavior of the patient and discuss points to keep in mind when treating such patients.