How extreme dieting becomes compulsive: A novel hypothesis for the role of anxiety in the development and maintenance of anorexia nervosa
How extreme dieting becomes compulsive: A novel hypothesis for the role of anxiety in the development and maintenance of anorexia nervosa
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DOI：
10.1016/j.mehy.2017.09.001
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发表时间：
2017-10-01
影响因子：
4.7
通讯作者：
Haase, A. M.
中科院分区：
文献类型：
--
作者：
Lloyd, E. C.;Frampton, I.;Haase, A. M.
美国国家心理健康研究所的研究领域标准 (NIMH RDoC) 提倡研究精神疾病的常见特征。这种跨诊断方法最近已被应用于神经性厌食症（AN）的研究中，神经性厌食症是一种本质上可以被认为是强迫性的疾病。这导致了对饥饿的解释的发展，该解释确定了饥饿强化的关键作用，导致饥饿过度重复和目标导向系统功能障碍。考虑到其他强迫症的疾病模型，我们扩展了现有的解释来解释 AN 中强化和目标导向系统异常的出现，并提出焦虑是这两个过程的核心。因此，我们强调饥饿的抗焦虑作用比其他强化结果更重要，在模型中鼓励饥饿的持续，该模型提出了焦虑在 AN 的发展和维持中发挥作用的多种机制。我们认为，AN 的精神病理学介导了饥饿的抗焦虑作用和过度重复饥饿之间的关系，并且强迫性饥饿对其决定因素具有相互影响。因此，我们解释了除强迫性饥饿之外的 AN 症状的出现，以及该疾病不同特征之间的关系。通过扩展和调整 AN 的现有解释，我们提供了一个更丰富的病因学模型，该模型提出了新的研究问题，并可以为预防和治疗的新方法提供信息。
The US National Institute of Mental Health's Research Domain Criteria (NIMH RDoC) advocates the study of features common to psychiatric conditions. This transdiagnostic approach has recently been adopted into the study of anorexia nervosa (AN), an illness that can be considered compulsive in nature. This has led to the development of an account of AN that identifies key roles for the heightened reinforcement of starvation, leading to its excessive repetition, and goal-directed system dysfunction. Considering models of illness in other compulsive disorders, we extend the existing account to explain the emergence of reinforcement and goal-directed system abnormalities in AN, proposing that anxiety is central to both processes. As such we emphasise the particular importance of the anxiolytic effects of starvation, over other reinforcing outcomes, in encouraging the continuation of starvation within a model that proposes a number of mechanisms by which anxiety operates in the development and maintenance of AN. We suggest the psychopathology of AN mediates the relationship between the anxiolytic effects of starvation and excessive repetition of starvation, and that compulsive starvation has reciprocal effects on its determinants. We thus account for the emergence of symptoms of AN other than compulsive starvation, and for the relationship between different features of the disorder. By extending and adapting an existing explanation of AN, we provide a richer aetiological model that invites new research questions and could inform novel approaches to prevention and treatment.