個案報告：以心智化為基礎的心理治療在後青春期非典型飲食疾患之治療運用

Case Report: Mentalization-Based Treatment for a Female College Student with an Atypical Eating Disorder

研究目的：青少年是飲食疾患的好發期，卻少有以此年齡層為研究對象的療效研究。本文以案例探討的方式介紹以心智化為基礎的心理治療（Mentalization-based treatment, MBT）在非典型飲食疾患的治療運用，提供專業同僚治療與研究後青春期飲食疾患之參考。研究方法：個案為21歲就讀於醫學大學的女學生，因長期感到孤單而求助於校內之學生輔導中心。她的非典型飲食疾患症狀包括主觀的狂食、自行催吐行為（每週2次，持續3個月以上），過度在意身材與體重，和接受治療的動機反覆不定。個案因不善表達自己的想法和與人建立合作同盟的關係，心理治療師運用以心智化為基礎的心理治療協助個案（1）建立治療關係、（2）探討目前的生活事件（如女大學生的發展議題）、（3）給予情緒同理、（4）區分人我想法差異的能力及（5）促進個體化的歷程（individualization）。個案從中學習如何調節情緒與協調人我之間的差異（心智能力），形成較接近外在客觀事實的身體形象，減少衝動性暴食與催吐的行為。研究結果：經51次的治療之後，個案自行催吐行為之強度與頻率皆顯著降低，且能意識到自己主觀認定的暴食失控行為與身材太胖和客觀事實的差距。個案能投入發展任務的學習並擁有正面的人際經驗。研究結論：本案例報告介紹心理治療師處遇青春期非典型飲食疾患的治療歷程。以心智化為基礎的心理治療之首要工作目標在增進個案的心智能力，與本個案研究發現一致。藉提昇個案的心智能力，則能有效地減少個案飲食行為失調的症狀，供專業同僚日後治療與研究後青春期飲食疾患之參考。

Purpose: Given the lack of developmentally sensitive and empirically supported treatments available for college students with eating disorders, this case report serves as a preliminary study to examine the effectiveness of mentalization-based treatment. Methods: The participant was a female college student with an atypical eating disorder and difficulty in expressing her thoughts and forming relationships. Her symptoms included subjective bingeeating and purging (twice a week for more than three months), and intensive preoccupation with body shape and weight. Mentalization-based treatment, which assists clients in effectively differentiating their own thoughts from those of other people, was conducted. Its essential therapeutic components are empathetic understanding and differential thinking. The goals are to help the client process therapeutic experiences and life events and to connect with feelings and thoughts in order to differentiate between subjective and objective perceptions of body shape and weight, and gain competence in developmental tasks. For instance, while the client tested the limits of the therapeutic time frames, the therapist helped her connect with her feelings and thoughts and differentiate her thoughts from others. Eventually, she was able to differentiate between her subjective and objective perception of body shape and weight and became more competent in her developmental tasks. This eliminated risk factors of dysfunctional eating behaviors. Results: After treatment, the client perceived her body shape and weight accurately and the frequency of her binge eating and purging behaviors decreased (from twice per week to almost none). In addition, the client developed positive relationships with her peers and parents and established effective strategies to fulfill her goals and develop satisfactory relationships with others. Conclusions: This case study provides preliminary support for a modified version of mentalization-based treatment as a therapeutic option for female college students with an atypical eating disorder.