神經性暴食症

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神經性暴食症
Bulimia nervosa
分类和外部资源
醫學專科
心理学

ICD-10
F50.2

ICD-9-CM
307.51
Patient UK
神經性暴食症

[编辑此条目的维基数据]


神經性暴食症（英语：Bulimia nervosa）又譯心因性暴食症或者神經性貪食症，一般簡稱為暴食症，是一種進食障礙，其特徵為患者會嘗試在暴飲暴食（英语：Binge eating）後試圖進行淨空行為。暴飲暴食代表在極短時間內攝取巨量食物，而淨空行為則是盡其所能消除所吃下的食物，例如透過嘔吐或服食瀉藥來達成[1]，也可能透過使用利尿劑、興奮劑、持續禁食或過度運動來努力減重[1][2]；不過，大部分患者的身高體重指數在正常值內[3]。如此強制性的嘔吐行為，可能導致關節皮膚增厚及牙齒破損。暴食症經常與其他精神病相關，如抑鬱、焦慮、藥物與酒精成癮等[1]，亦有高風險的自殺與自殘傾向[4]。


如果近親有暴食症症狀，其家族內較普遍有其他暴食症患者[1]；遺傳導致暴食症的風險比例約為30%至80%[2]。其餘導致患病的風險因素包含心因型壓力（英语：Psychological stress）、對於標準身型的社會文化壓力、自尊低落和肥胖症等[1][2]。生活環境中若有家長擔心體重的狀況或推廣節食的文化價值觀，也有風險導致罹患暴食症[2]。通常會基於個人病史來診斷是否罹患暴食症[5]，但若患者否認有暴飲暴食與淨空行為時則難以確診[2]。如果病人曾被診斷為神經性厭食症，則應依照此診斷[2]。其他類似的疾病包括過胖暴食症、克萊恩-萊文症候群和邊緣性人格障礙等[5]。


認知行為療法是暴食症主要的治療方式[1][6]。選擇性5-羥色胺再攝取抑制劑 (SSRI) 或 三環類抗抑鬱藥類抗抑鬱藥物通常具有一定療效[7][2] 。儘管神經性暴食症患者較神經性厭食症患者相比預後較佳，但患者的死亡風險較健康人群高[4]。約五成患者在接受治療的十年後狀況完全改善[2]。


女性的暴食症發病率約為男性的9倍，其中年輕婦女患病率最高[5] 。 1979年，暴食症由英國精神科醫師格拉德‧羅素（英语：Gerald Russell）首次命名並描述[8][9]




目录






  • 1 好發族群


  • 2 病徵及心理


  • 3 對身體之傷害


  • 4 参考文献


  • 5 外部連結


  • 6 參見





好發族群


患者多為成年的年輕女性，通常天生身材就稍微胖一點，或者根本就是標準體重，且在青少年時期（初、高中階段）曾多次嘗試減重。這些患者通常與家人相處狀況也不是很好。



病徵及心理


病患會在四下無人時瘋狂的吃下許多食物，接著心理產生罪惡感而去催吐（或服用瀉藥），催吐完會暫時紓解心中罪惡感。但是病患隨即會感到「催吐這種行為是可恥的」而產生焦慮，導致病患會以「吃下大量食物」來紓解焦慮。這是一個無窮的循環。通常患者吃下來的食物每次總熱量高達10000~15000 Kcal，通常是一些速食、高熱量食物。由於患者會在四下無人情況下進行這些行為，所以臨床上要檢查出來非常的困難，通常必須由好友、家人發現，另外牙醫師檢查牙齒時，亦可由牙齒琺瑯質的改變診斷出患者。另外這些患者會有過度運動情形。



對身體之傷害



  • 發胖：雖然患者會自行將吃進去的食物嘔吐出，但通常仍會有約30~75%的食物被吸收，相當可觀。如果是吃瀉藥方式，吸收的食物高達九成。

  • 運動傷害：患者擔心吃下的食物會造成發胖，所以會過度的運動。

  • 心理障礙：患者易產生自卑、憂鬱之心理。

  • 牙齒損傷：催吐時胃酸造成牙齒脫鈣現象。

  • 心灼熱：催吐時胃酸腐蝕食道，造成心灼熱。

  • 血鉀濃度過低

  • 唾腺發炎：胃酸腐蝕唾腺造成。

  • 便秘：由於排遺量減少造成便秘。



参考文献





  1. ^ 1.01.11.21.31.41.5 Bulimia nervosa fact sheet. Office on Women's Health. July 16, 2012. [27 June 2015].  请检查|date=中的日期值 (帮助)


  2. ^ 2.02.12.22.32.42.52.62.7 Hay PJ, Claudino AM; Claudino. Bulimia nervosa. Clinical Evidence. 2010, 2010: 1009. PMC 3275326. PMID 21418667. 


  3. ^ Bulik, CM; Marcus, MD; Zerwas, S; Levine, MD; La Via, M. The changing "weightscape" of bulimia nervosa.. The American journal of psychiatry. October 2012, 169 (10): 1031–6. PMID 23032383. 


  4. ^ 4.04.1 Smink, FR; van Hoeken, D; Hoek, HW. Epidemiology of eating disorders: incidence, prevalence and mortality rates.. Current psychiatry reports. August 2012, 14 (4): 406–14. PMID 22644309. 


  5. ^ 5.05.15.2 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders Fifth. Arlington, VA: American Psychiatric Publishing. 2013: 345–349. ISBN 978-0-89042-555-8. 


  6. ^ Hay, P. A systematic review of evidence for psychological treatments in eating disorders: 2005-2012.. The International journal of eating disorders. July 2013, 46 (5): 462–9. PMID 23658093. 


  7. ^ McElroy, SL; Guerdjikova, AI; Mori, N; O'Melia, AM. Current pharmacotherapy options for bulimia nervosa and binge eating disorder.. Expert opinion on pharmacotherapy. October 2012, 13 (14): 2015–26. PMID 22946772. 


  8. ^ Russell G. Bulimia nervosa: An ominous variant of anorexia nervosa. Psychological Medicine. 1979, 9 (3): 429–48. PMID 482466. doi:10.1017/S0033291700031974. 


  9. ^ Palmer R. Bulimia nervosa: 25 years on. The British Journal of Psychiatry : the Journal of Mental Science. 2004, 185 (6): 447–8. PMID 15572732. doi:10.1192/bjp.185.6.447. 




外部連結


  • About.com's Eating Disorders site


參見


  • 神經性厭食症

























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