Anorexia nervosa: Social developmental aspects in long-term follow-up.

摘要

Anorexia nervosa, that puzzling, self-induced starvation, is increasingly prevalent among adolescent girls, with estimates that one girl in every 250 between the ages of 11 and 20 may be seriously affected by eating disorders (American Psychiatric Association, 1987).;This thesis, using a combination of quantitative and qualitative methods, traces the progress of thirty young women who were hospitalized at Children's Hospital between 1972 and 1982. Medical records were related to the results of a follow-up in 1985. Eighty-three percent were recovered or had mild impairment, while 17% remained seriously impaired at follow-up. A small group (10%) were recovered in medical and psychological terms but still had difficulties in interpersonal relations. Patients gave high ratings to the interpersonal aspects of their treatment, underscoring their healing value.;The State of Mind Questionnaire (Piazza, Rollins & Lewis, 1983a) was validated in this research as an effective measure of severity and change in anorexia nervosa. Furthermore, the Self/Other scale within the larger measure served as a succinct summary of the severity of body-image distortion and therefore of anorexia. This suggests its use as a screening device by school or medical personnel to facilitate early intervention which has a positive affect on prognosis.;Interviews conducted in 1990 with a subset of the original follow-up group, found most women recovered in symptomatic terms, although several were isolated and friendless.;Anorexia is a complex disorder caused by a combination of socio-cultural, familial, and individual factors all interacting with an adolescent woman's developmental needs. Increasingly practitioners find that favorable outcome relates to therapeutic interventions which facilitate successful mastery of adolescent tasks of emotional development (Rollins & Piazza, 1981).;A strong interpersonal theme that emerged from the interviews was the role of a male authority figure who delivered a message combining fear and care at a critical turning point in recovery. This finding calls for further research to examine potential treatment implications. Those women who were able to integrate the fear/care message and reframe it in terms of caring for themselves and others appeared to be the most physically and psychologically healthy.