Primary anorexia nervosa.
Primary anorexia nervosa.
复制标题
原发性神经性厌食症。
作者：
A. H. Crisp
In recent years, psychiatrists'2'3'4'5'have been studying anorexianervosa systematically, and it has been proposed6'7'8'that a state ofprimary anorexia nervosa, occurring mainly in young, adolescentgirls, can be identified and separated from other states of'nervousmalnutrition'. 9 The condition is a rare one, but the recent reports have all been concerned with 50 or more typical patients as thebasis for their respective studies. From a psychological standpoint the condition has usually been viewed as primarily a feeding problem, but recently Bruch'0 has emphasized the central psychological need of these patients to be thin, and Crisp6 has claimed that the psychological posture can most usefully be viewed as a phobia andconsequent avoidance of normal adolescent weight, the disorder pivoting around thematurational changes of puberty and their psychosocial implications for the patient. The presence and nature of such psychological difficulties at the time of onset ofthe disorder is often subsequently obscured by the patient's obstinate and fearful denial of such problems which she has only been able to solve or minimize through theprocess of her illness. As a group, although not invariably so as individuals, the patientsare characterized'by having been overweight in conjunction with a high growth rate. It has also been proposed6 that the differential sex incidence (the condition is about 20 times more common in females than in males) may be related to several factors, including the higher rate of growth and earlier maturation of girls, the special sexual conflicts confronting women in adolescence, such as the risk of pregnancy, as well as the greater tendency for girls to wish to beslender and thereby to embark on dieting and carbohydrate elimination from time to time, thus providing the most common initial mechanism from which the disorder can stem. Treatment is usually aimed at restoring body weight to a normallevel. This invariably requires hospital admission and the techniques for achieving it are various. Most psychiatrists agree that the patient needs to be in hospital for at least three months and under close supervision during this time. Phenothiazine drugs are often used and itmay be" l that these drugs have a specific effect of increasing the capacity to eat as well as serving to allay associated anxiety and reducing activity. Some workers have used insulin in small doses in an effort to increase appetite. However, there is little evidence'2 that these patients are naturally depleted of insulin or unresponsive; furthermore they are usually, by normal standards, already mildly hypoglycaemic. Although they often deny it, the majority of them are consciously contending with hunger and a desire to eat for much of the time. It is probably important to retrain these patients to eat normal meals, including sensible amounts of carbohydrate, rather than attemptingto restore their weight by artificial feeding. It isgenerally agreed that restoration of weight is an inadequate criterion of recovery and that psychological help is often needed if the patient is to cope with and tolerate the implications of her own restored weight. If this is not available, or if the patient believes that she cannot be helped in this way, then she is unlikely to stay in hospital long enough to have her weight fully restored.
