飲食疾患之認知行為治療

Cognitive Behavioral Therapy for Eating Disorders

飲食疾患包括厭食症與暴食症，厭食症的特徵為拒絕維持最低的正常體重；暴食症的特徵則為反覆暴食發作，並伴隨不適當的代償行為，像是自我催吐、濫用瀉劑、利尿劑或其它藥物、禁食或過度運動。飲食疾患早期不易被察覺，且病患經常隱藏自己的異常飲食問題，拒絕醫療協助，通常危及生命健康，才由親友師長協助其就醫，使得病程慢性化，增加治療的困難。認知行為治療是飲食疾患的治療方式中被認為確實有效的，著重在直接改變構成飲食疾患的認知與行為，透過半結構式的指引與教育，以修正偏差的認知與行為。本文針對近五年國內外期刊雜誌對於飲食疾患的治療成效所作之綜論加以回顧，發現尤以認知行為治療成效為佳。故全文以認知行為治療為主軸，護理人員可運用認知行為治療的模式來協助病患面對飲食疾患的核心信念－－過度在意體型體重的問題，發揮獨特的護理專業功能，幫助病患恢復健康。

Eating disorders include anorexia nervosa and bulimia nervosa. The former is characterized by failure to maintain a minimum normal body weight, while the latter is typified by recurrent binge eating followed by inappropriate compensating behavior, which may include self-inducing vomiting; abuse of laxatives, diuretics or other medications; fasting; and over-exercise. Because eating disorders are difficult to detect in the early stages and patients frequently try to hide their condition and avoid seeking medical help, medical treatment is sometimes sought only once a patient's condition poses an immediate threat to his/her health, or even life. Some patients suffer from chronic and treatment-refractory disorders. Cognitive behavioral therapy, administered through partially-structured guidance and education, has been shown to treat eating disorders effectively by correcting associated maladaptive and distorted cognitions and behaviors. A review of articles published in the domestic and international literature over the past five years show that cognitive behavioral therapy is more effective in treating eating disorders than other traditional approaches. Therefore, we chose to focus this study on the cognitive behavioral therapy model. Nurses can employ cognitive behavioral therapy to help eating disordered patients address and overcome the core beliefs that underpin their disorder (e.g., compulsive concern about body weight or figure) and recover health.