暴饮暴食厌食催吐泻药hellip

Thecognitivebehavioralprocessesinvolvedinmaintainingeatingdisorders.

从认知行为角度，哪些具体流程，导致了饮食障碍的持续存在？

Whenwestudyeatingdisorders,itisimportanttodistinguishtheprocessesthatmayhavecausedtheproblemtostart(causesofeatingdisorders)fromthosethathaveledittopersist(maintainingfactorsofeatingdisorders).Inotherwords,weneedtotrytoanswerthosetwokeyquestions:

当我们研究饮食障碍时，需要区分可能导致问题发生的流程（饮食障碍的起因）以及维持问题持续存在的流程（饮食障碍的维持因素）。换言之，我们需要回答两个关键问题：

1.Whydoeatingdisordersdevelop?为何会形成饮食障碍？

2.Whydoeatingdisorderspersist?为何饮食障碍会持续存在？

Thisrequiresdistinguishingtheso-calleddevelopmentphase(i.e.,beforetheonsetoftheeatingdisorder)andthemaintenancephase(i.e.,afteritsonset).Thisdistinctionhastwoimportantimplications:(i)identifyingtheprocessesthatinfluencedthedevelopmentofeatingdisordersmayhelptodesigneffectivepreventioninterventionsofthesedisorders;(ii)identifyingtheprocessesthatmaintaintheeatingdisordermayhelptodevelopsuccessfultreatmentinterventions.

这就需要区分所谓的形成阶段（即，饮食障碍开始之前）以及延续阶段（即，开始之后）。这一区别有两个重要的作用：1）找出影响饮食障碍形成的流程，可以有助于制定有效的预防干预方案；2）找出维持饮食障碍持续存在的流程，有助于制定有效的治疗干预方案。

Unfortunately,thecausesofeatingdisordersarestillnotwellknown.However,wenowhaveabetterunderstandingofthecognitiveandbehavioralprocessesthatmaintaineatingdisordersandtheirknowledgehashelpeddevelopmoreeffectivepsychologicaltreatments.

不幸的是，饮食障碍的起因至今尚未得到充分研究。但我们对维持饮食障碍持续存在的认知行为流程已经有了更好的认知，这些认知已经帮助我们制定了更为有效的心理治疗方案。

Keyprocessesthatmaintaineatingdisorders维持饮食障碍的关键流程

Accordingtocognitivebehaviortheory,adistinctiveself-evaluationscheme(Figure1),i.e.,theovervaluationofshape,weight,eatingandtheircontrol(inotherwords,judgingself-worthlargely,orevenexclusively,intermsofshape,weightandonesabilitytocontrolthem)isofcentralimportanceinmaintainingeatingdisorders.

根据认知行为学理论，一种独特的自我评估方式（图1），即，对体型、体重、饮食以及对上述方面的控制能力的过度评估（换言之，很大程度，甚至只以体型、体重以及个人对体型体重的控制能力来判断个人价值），在饮食障碍的持续存在中占据着核心位置。

Indeed,theotherclinicalfeaturesseeninthesedisordersseemtoderivedirectlyfromthis“core”psychopathology.Theseincludeextremeweight-controlbehaviors(e.g.,dietaryrestraint,dietaryrestriction,self-inducedvomiting,laxativeanddiureticmisuse,andexcessiveexercising),variousformsofbodycheckingandavoidance,feelingfat,andpreoccupationwitheating,weight,andshape.Thesefeaturesofeatingdisordersareinfactexpressionsoftheindividual’sbeliefthatcontrollingtheirweight,shapeandeatingisofextremeimportanceintheirself-evaluation.

的确，饮食障碍中的其他临床特征似乎都直接源于这一“核心”认知行为特征。这些临床特征中包括：极端体重控制行为（如，饮食节制、饮食限制、催吐、导泻与利尿药物滥用、过度锻炼）、各种形式的体型体重检测和身体回避、感觉肥胖、执迷于饮食、体重和体型等。饮食障碍的这些特征实际上是个人“控制个人体重、体型和饮食在自我评估中极度重要”这一认知的外在表现。

间歇性暴饮暴食的形成与延续机制

Theonebehaviorthatisnotadirectexpressionoftheovervaluationofshape,weight,eatingandtheircontrolisthebinge-eatingepisode.Thisbehaviorispresentinalargesubgroupofpeoplewitheatingdisorders,anditderivesindirectlyfromthisovervaluationthroughthefollowingmechanisms:

上述过度评估方式的一个非直接外在表现是间歇性暴饮暴食。这种行为在患有饮食障碍的一个很大亚群体中普遍存在。它是通过以下机制间接形成的：

1.Severeundereating.Theovervaluationofshape,weight,eatingandtheircontrolcanleadanindividualtoundereat.Doingsoproducesseveralchangesoftheneuroendocrinesignalswhichcontrolfoodintake,messaginghungeroversatiety/satiation.

1.严重饮食不足：对体型、体重、饮食及控制能力的过度评估，会导致一个人饮食不足，这会导致控制饮食摄入的神经内分泌信号发生剧烈变化，在饱腹之后依旧会发送饥饿信号。

2.Extremeandrigiddietaryrules.Peoplewitheatingdisorderstendtoreactinanegativeandextreme(oftenallornothing)waytothealmostinevitablebreakingoftheseextremeandrigiddietingrulesandevenasmalltransgressiontendstobeinterpretedasevidenceofpoorself-controlandpersonalweakness.Thereactiontothisperceivedlackofself-controlisatemporaryabandonmentoftheefforttorestricttheirdiet,whichresultsinabinge-eatingepisode.This,inturn,intensifiesconcernsandbeliefsregardingtheirlackofcontrolwhenit

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