Bulimia Nervosa の発病に関与する心理的要因について

DOI Web Site 被引用文献2件
  • 笠原 敏彦
    北海道大学医学部附属病院精神科神経科
  • 田中 哲
    北海道大学医学部附属病院精神科神経科

書誌事項

タイトル別名
  • Psychological Factors Which Play Etiological Role for Bulimia Nervosa
  • Bulimia Nervosa ノ ハツビョウ ニ カンヨスル シンリテキ ヨ

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Bulimia nervosa is an episodic pattern of chaotic eating that is accompanied by several other symptoms. The patient generally engages in binge eating-the rapid consumption of a large amount of food in a discrete period of time, usually less than 2 hours. Other symptoms include an awareness of the disordered eating pattern with the fear of not being able to stop eating voluntarily, depressive moods and self-depreciating thoughts after the episodes of binge eating, and repeated attempts after binging episodes to lose or control weight through severely restricted diets or purging behavior such as self-induced vomiting or laxative abuse. The patient has a persistent overconcern with body shape and weight. Bulimia nervosa has long been recognized as one aspect of the disordered eating habits of patients with anorexia nervosa or obesity. Some investigations have demonstrated that the development of bulimic symptoms among patients with anorexia nervosa has important etiological, prognostic and clinical implications. But bulimia nervosa also appears to be occurring at an alarming rate among women of normal weight who do not have histories of anorexia nervosa. Despite the increased incidence and seriousness of bulimic behavior, there were no studies in Japan which have reported on the situational and psychological problems as precipitating factors of bulimia nervosa. We studied fifty patients (48 females and 2 males) who satisfied the diagnostic criteria for bulimia nervosa of DSM-III-R. The mean age at the onset was 19.1 years (SD±3.6). Patients were divided into four groups according to their disordered eating behavior observed at or before the onset of bulimia nervosa. 1. Binge eating group (N=5) Recurrent episodes of binge eating occurred form the beginning of bulimia. 2. Appetite loss group (N=7) Appetite loss which was not based on voluntary dieting has continued for considerable periods of time (mean 12.0 months; SD±18.7) before the onset of bulimia. 3. Voluntary dieting group (N=29) Voluntary restriction of food intake aiming at slim figure has continued for considerable periods of time (mean 9.9 months; SD±5.9) before the onset of bulimia. 4. Self-induced vomiting group (N=9) Self-induced vomiting which aims at slim figure has continued for considerable periods of time (mean 9.0 months; SD±9.0) before the onset of bulimia. Patients of the binge eating group and the appetite loss group had often psychological stresses in their life situations; interpersonal problems with family, friends or colleagues, persistent worries about achievement in school or company, etc. Cases of the voluntary dieting group and the self-induced vomiting group had such psychopathological problems as distorted body image, intense fear of becoming obses, dysmorphophobia, social phobia, narcissistic or borderline personality disorder. We concluded that bulimia nervosa is a paradigmatic psychosomatic disorder and that anorexia nervosa and bulimia nervosa are not the two separate dichotomous syndromes, but the extreme counterparts of the same disorder. It will be shown that these two conditions can alternate in the same person and that the same psychological factors play important etiological roles in both conditions.

収録刊行物

  • 心身医学

    心身医学 30 (2), 137-144, 1990

    一般社団法人 日本心身医学会

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