社會節律對女性亞臨床嗜食症族群暴食行為之影響

研究目的：飲食障礙症的成因複雜，其中嗜食症的盛行率最高，人數增加也相當迅速。過往研究多以情緒因應來解釋暴食的發生，然而在臨床經驗以及部分療效研究中卻看到，當改善患者的生活穩定性，像提供規律用餐、運動、穩定睡眠的幫助後，能降低暴食行為。因此本研究透過主觀記錄和客觀量測亞臨床嗜食症患者的社會節律，來探討社會節律與暴食之間的關係。研究方法與結果：本研究在大學校園招募參與者，先排除嚴重失眠、輪班工作，以及有精神疾患者，篩選出有達亞臨床程度暴食行為但BMI處在正常範圍的24名參與者。參與者先完成前測問卷，包含情緒性飲食、自我控制、飲食障礙症相關病理的測量，並在之後的兩週持續填寫社會節律表格，同時採用生態瞬間評估法(Ecological Momentary Assessment, EMA)，進行飲食行為的評估，期間會讓參與者配戴活動紀錄腕表，以追蹤活動量的變化與節律，兩週後的後測再讓參與者填寫主觀睡眠品質、壓力知覺以及情緒的紙本問卷，最後共20名參與者完成研究。研究發現：1)在控制情緒性飲食和負向情緒程度後，客觀測量的社會節律能夠顯著預測飲食障礙症量表中暴食分量表的分數；2)前、後測的自陳問卷和社會節律皆無法預測EMA所記錄到的實際暴食次數；3)普通飲食和暴食相比，活動量的相對生理時鐘功率在普通飲食前後有顯著上升。結論：本研究結果發現客觀量測的社會節律能預測暴食行為，雖然主觀紀錄無法直接預測，但經由主觀記錄的輔助可以了解各活動量指標並非單一向度而是會受特定生活事件影響。因此本研究認為兩種測量方式能互補提供更為完整的社會節律資訊，對於飲食疾患的預防能提供更多的線索。

關鍵字

亞臨床嗜食症；社會節律；暴食行為

並列摘要

Objection：Binge eating disorder has a rising incidence rate and the highest prevalence among eating disorders. Previous researches about the contributing factors of binge eating focused more on the influence of emotional factors, some efficacy studies and clinical observations have demonstrated that stabilibility of the daily life activities, including regular exercise, meal patterns, and sleep time, can also influence binge eating behavior. Therefore, this study aims to examine the association between binge eating behavior and social rhythm through subjective recording and objective measure (wrist actigraph) of social rhythms in female participants with subclinical binging eating disorders. Method and Result： 24 participants with mild binge eating and normal BMI were recruited from university campuses. Potential participants with insomnia, mental illnesses, and those who were shift workers were excluded. They had to complete a package of pre-test questionnaires for the measures of emotional eating, self-control, and etiology of eating disorders. They were then required to wear a wrist actigraph, to keep daily social rhythm metric, and to record their eating behavior with ecological momentary assessment (EMA) for two weeks. Subsequently, participants had to fill out a package of post-test questionnaires regarding theri sleep quality, stress, emotion. Twenty participants completed the study. The result showed that: 1) the social rhythm assessed by actigraphy can predict the score on the bulimia subscale of Eating Disorder Inventory (EDI) , even after controlling the degree of emotional eating and negative affect; 2) the scores of both the pre-test and post-test questionnaires, as well as the social rhythm metric could not predict the number of binge eating assessed by EMA; 3) the power of circadian rhythm of physical activity following usual diet was higher than that following binge eating. Conclusion： The result showed that social rhythms as measured by physical activities could predict binge eating behaviors. Although the subjective reports of social rhythms did not preict binge eating behaviors directly, they were shown to be associated with different aspects of objectively measured rhythms. It was suggested that social rhythm has a multi-dimensional construct and should be assesed by both subjective and objective means, in order to provide more information for preventing eating disorders.