摂食障害の心理社会的発症要因と中・長期経過(摂食障害の中・長期経過第30回日本心身医学会総会)

Psychosocial factors and their reference to middle-term and long-term courses were investigated in the patients with anorexia nervosa (AN) and bulimia nervosa (BN). The subjects were three males and 33 females with the mean age of 25.6 years referred to the neuropsychiatric clinic of Fukushima Medical College Hospital and its related hospitals. Based on the criteria of DSM-III-R, they were classified into three groups; 14 cases of typical AN group (typical group), 11 cases of atypical AN group (atypical group), and ll cases of BN group. The typical group fulfilled the whole criteria, but the atypical group fulfilled only some of them. Among the evaluated psychosocial factors (personality trait, serious family pathology, psychosocial stressors, and precipitating factors), obsessive compulsive personality trait and precipitating factors on the body image of patients were characteristic of the typical group. On the other hand, serious family pathology and severe psychosocial stressors were more remarkable in the atypical group. Important psychosocial factors in the BN group were borderline, obsessive compulsive, or dependent personality traits and precipitating factors on self-supporting ability. The middle-term outcome (five years after onset) was favorable in 71.5% of the typical group, 54.5% of the atypical group, and 45.5% of the BN group. In the unfavorable cases, there were relatively long duration of binge eating and severe mental symptoms such as suicidal attempts and self-mutilating behaviors. Concerning psychosocial factors, unfavorable outcome could be connected mainly with borderline personality traits in all of the three groups. Fourteen cases were examined on the long-term outcome (more than ten years after onset with the mean term of 12.5 years). In both the typical and atypical groups, the outcome of eating behavior tended to be good. However, a few cases in the both groups showed severe mental symptoms which were mainly attributable to personality disorders. The outcome of the BN group was relatively good not only with eating behavior but with mental symptoms. Like middle-term prognosis, personality trait played a major part for deciding long-term prognosis. Namely, the patients with obsessive compulsive personality trait were led to good outcome, while borderline, dependent, or narcissistic personality traits could become worse and develop into personality disorders, and therefore might be related to poor outcome. These results suggest that personality trait might influence the course and outcome of eating disorders.