狂食症之心理治療－病例報告

Psychotherpy for Binge Eating Disorder: A Case Report

林彥妤(Lily Yen-Yu Lin) ； 陳冠宇(Kuan-Yu Chen)

《北市醫學雜誌》 10卷3期 (2013/09) Pp. 273-276

https://doi.org/10.6200/TCMJ.2013.10.3.10

摘要

目的：狂食症是盛行率最高的飲食疾患。屬於好發期的青少年飲食疾患卻少有治療研究。本文將介紹結合發展病理觀點（developmental psychopathology perspective）與認知行為治療來協助後青春期狂食症之個案報告，供專業同儕參考。個案報告：個案為大一女學生，狂食行為失調已達5個月，不但使體重遽增，且引發負向情緒的連鎖反應（如狂食後的挫折、引發親子關係的緊張）。心理治療師（1）透過以認知行為治療為架構的飲食紀錄，協助個案瞭解飲食行為失調中前置事件－情緒－思考的相互關係；（2）由發展病理觀點拓展個案對前置事件的意義探討；（3）協同家人共同參與治療，協助個案適應大學環境，降低狂食行為。為期5個月（18次）治療後，在17個月之後追蹤，個案無暴食失控行為且能主動投入大學生活。討論：融合發展病理觀點與認知行為治療於後青春期狂食症之治療成效良好，值得實務與未來療效研究之參考。

關鍵字

狂食症 ； 認知行為治療 ； 發展病理觀 ； 青少年

並列摘要

Objective: Binge eating is the most common eating disorder among adolescents. We reported the preliminary outcome of a a modified cognitive behavior therapy for an adolescent with binge eating disorder from a developmental psychopathology perspective. Methods: The client was a female first-year college student suffered from binge eating disorder for more than five months. Her symptoms included an increase in BMI from 15.8 to 23.65 and negative emotional escalations related to binge eating episodes and conflicts with parents. The therapist used cognitive behavior therapy to assist the client in connecting binge eating episodes with anticipant events, relevant emotions and thoughts. For instance, in the fifth session, the client realized that after receiving counseling, she only had a binge eating episode before the appointment in order to have appropriate reasons for counseling. When the therapist encouraged her to freely discuss any issues she wished in sessions, the client talked about her desire to be as mature as her peers. The therapist assisted her in exploring what maturity meant and her ambivalent attitude toward being maturity. The therapist also used a developmental psychopathology perspective to broaden the client's understanding of anticipant events. Two meetings with the client's mother served to enhance understanding of the relationships between client's binge eating episodes and college adjustment issues were hold as clinically indicated. For instance, the client needed to cultivate her sense of autonomy. Results: After 18 therapy sessions, the client fully participated in her college life and had no binge eating episodes during a 17-month follow-up period. Conclusions: This case report offers insights for colleagues dealing with adolescent binge eating disorder. The essential therapeutic component of modified cognitive behavior therapy for adolescents or young people is to put clients' binge eating episodes into a developmental context and to include family members to facilitate clients' individualization.

並列關鍵字

binge eating disorder ； developmental psychopathology perspective ； adolescence

參考文獻

American Psychiatric Association. Eating Disorder. In Text Revision of Diagnostic and Statistical Manual of Mental Disorders, DSMIV- TR. Washington DC: American Psychiatric Association：2000：583-95.

Chamay-Weber C, Narring F, Michaud PA: Partial eating disorders among adolescents: A review. Journal of Adolescent Health; 2005; 37: 417-27.

Safer DL, Couturier JL, Lock J: Dialectical behavior therapy modified for adolescent binge eating disorder: A case report. Cognitive and Behavioral Practice 2007; 14(2): 157-67.

Fichter MM, Quadflieg N, Gnutzmann A, et al: Binge eating disorder: treatment outcome over a 6-year course, J Psychosom Rec 1998; 44:385-405.

Zweig RD, Leahy RL: Treatment plans and interventions for bulimia and binge-eating disorder. New York: Guildford, 2012.