神経性食欲不振症の病態発生機序に関する心身医学的考察(思春期の心身症(第16回日本精神身体医学会総会より))

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The pathoplastic mechanism of anorexia nervosa has been explained from somatic, psychodynamic, psychopsysiological and other specific points of view. However, a comprehensive approach is important to understand this mechanism, particularly in connection with clinical practice.The author reviewed 56 patients who had been examined or treated as anorexia nervosa at our department during the years from 1965 to 1974 and fulfilled the criteria which we devised for the present study, with particular attention to clinical phenomena, family backgroud, personality development as well as bodily experiences.The results were as follws : 1) A certain hypothalamic dysfunction, which could not always be attributed to starvation, was indicated in some patients.2) It was thought that in most patients the mother-child relationship and family background were unsuitable to their psychosomatic development from early infancy through leter periods.3) It was recognized that most patients had had some disturbances in interaction with the outer world since infancy. These disturbances manifested themselves particularly in the forms of disturbed object relationship and poor autonomy in eating behavior and/or body weight regulation. On the other hand, characteristic adaptive efforts, such as controlling their own body and bodily function, clinging to certain norms and complying with the outer world, were observed to have been developed, to compensate for these disturbances.4) Our observations elucidated that their bodily experiences were fillied with infantile anxiety, that is, anxiety about disintegration of their own personality as well as about impending loss of the object world.On the basis of these observations, a following hypothetic interpretatino of the pathoplastic mechanism in anorexia nervosa was assumed : With the advent of adolescence when instinctual drives are heightened, the adaptive efforts of anorectic patients become insufficient, inducing the fortified efforts to compensate for themselves as a defense mechanism. As the result, there is decreased interaction with the outer world, which may bring about a certain abnormality in somatic basis of integrating homeostasis. This abnomality, in turn, is supposed to reactivate infantile anxiety concerning bodily experiences and consequently intensify the same defense mechanism. At this point, a psychosomatic structure is thought to be formulated as a vicious circle.
日本心身医学会の論文
1976-02-01

神経性食欲不振症の病態発生機序に関する心身医学的考察(思春期の心身症(第16回日本精神身体医学会総会より))

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