強迫性を有する神経性食欲不振症患者の臨床的特徴および完全主義について  [in Japanese] Clinical Features and Perfectionism in Obsessive Anorexia Nervosa Patients  [in Japanese]

強迫性を有する神経性食欲不振症(AN)患者の臨床的特徴を調べ,さらに完全主義との関連について検討した.対象は当科で入院にて『行動制限を用いた認知行動療法』を行った女性AN患者85名.入院時に施行したMaudsley Obsessional Compulsive Inventoryで13点以上を高強迫性群,13点未満を低強迫性群とした.高強迫性群はANの発症年齢がより低かった.両群間でANの病型に違いはみられなかった.また入院治療からのドロップアウト率と体重の増加は両群間で差がなく,AN患者の強迫性が,『行動制限を用いた認知行動療法』に基づく入院治療の経過に及ぼす影響はほとんどないと考えられた.Eating Disorder Inventoryでは,高強迫性群で「内界への気づきの欠如」「無力感」「完全主義」などの心理的特徴との関連が認められた.Multidimensional Perfectionism Scaleで,高強迫性群は,低強迫性群と比べて総得点が高く,高い完全主義がみられた.さらに高強迫性群では,自分が自分に完壁さを要求する「自己志向的完全主義」や他人から自分に対して完璧さを要求されていると感じる「社会規定的完全主義」との関連がみられた.

We examined the clinical and psychological features of obsessive anorexia nervosa (AN) patients and discuss the relationship between obsession and perfectionism in AN. Participants were eighty-five AN inpatients who received cognitive behavioral therapy with behavior restriction in our hospital. We classified these AN patients into two groups according to the severity of obsession by use of the Maudsley Obsessional Compulsive Inventory done at admission: A higher obsessive (HO) group who scored 13 points and above and a lower obsessive (LO) group that scored lower than 13 points in the test. The age at onset of AN was lower in the HO group than in the LO group. The percentage of patients with AN subtypes did not differ between the two groups. No difference was found in the rate of drop-out from inpatient treatment and incremental body weight gain during hospital stay between the two groups, suggesting that obsession in AN patients had little influence on the course of inpatient treatment based on cognitive behavioral therapy with behavior restriction. The HO group was associated with the Eating Disorder Inventory subscales "interoceptive awareness", "ineffectiveness" and "perfectionism". Multidimensional Perfectionism Scales revealed that the HO group had higher total scores and higher scores on almost every perfectionism subscale, including self-oriented and socially oriented perfectionism, than the LO group.