神经性厌食患者的家庭环境特征与临床症状

Relationship between features of family environment and clinical symptoms in patients with anorexia nervosa

目的:了解中国文化背景下神经性厌食(AN)患者的家庭环境特征及其与临床症状之间的关系,为探索如何通过改善家庭环境而减轻临床症状提供依据。方法:选取符合精神障碍诊断与统计手册第4版修订版(DSM-Ⅳ-TR)诊断标准的AN患者93例(限食型44例,暴食/消除型49例),选取性别、年龄、婚姻、受教育程度相匹配的正常对照86例。对两组被试采用家庭环境量表中文版(FES-CV)评定家庭环境和社会特征的10个不同方面,采用症状自评量表(SCL-90)评定被试的精神症状特点,采用饮食态度调查表(EAT-26)评定被试的进食态度,并通过SCL-90和EAT-26反映被试的临床症状。结果:AN患者的FES-CV的亲密度、情感表达、知识性和娱乐性因子得分低于正常对照[7.0(0,9)vs.8.0(3,9),5.5(0,9)vs.7.0(2,9),2.0(0,8)vs.3.0(0,9),3.0(0,9)vs.5.0(0,9),均P<0.05],矛盾性因子分高于正常对照[5.0(0,9)vs.2.5(0,7),P<0.05]。与限食型患者相比,暴食/消除型患者的情感表达和知识性因子分较低[6.0(1,9)vs.5.0(0,8),3.0(0,8)vs.2.0(0,7),均P<0.05]。将AN患者按照BMI分组,中度组和极重度组的亲密度因子分均高于重度组[7.0(0,9),8.0(0,9)vs.5.5(0,9),均P<0.05]。FES-CV量表的亲密度、情感表达、娱乐性因子得分与SCL-90总分负相关(r=-0.39、-0.28、-0.22),矛盾性因子与SCL-90总分正相关(r=0.24);FES-CV亲密度因子与EAT-26总分负相关(r=-0.24),矛盾性因子与EAT-26总分正相关(r=0.32);FES-CV亲密度、情感表达、娱乐性因子与疾病病程负相关(r=-0.27、-0.28、-0.23),均P<0.05。结论:神经性厌食患者的家庭环境具有低亲密度、低情感表达、低娱乐性和高矛盾性等特征,家庭低亲密度与较差的精神症状程度和进食态度及较长的病程相关。

Objective： To investigate the relationship between the characteristics of family environment and clinical symptoms in patients with anorexia nervosa （AN） in the background of Chinese culture. Methods： Totally93 patients （44 cases of restricting type, 49 cases of binge-eating/purging type） meeting the criteria of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision（DSM-IV-TR） and 86 gender-, marriage- and education-matched normal controls were selected. They were assessed with the Family Environment Scale-Chi- nese Version（FES-CV） to evaluate the characteristics of family environment, and some scales for clinical symptoms, i. e. with Symptom Checklist 90 （SCL-90） to assess the characteristic of psychological symptom, and with Eating Attitude Test-26（EAT-26） to assess the overall eating attitude. Results： Compared with the controls, the AN patients showed lower FES-CV median（minimum, maximum） factor scores of cohesion, expressiveness, intellectualcultural orientation and active-recreation orientation[ 7.0（0, 9） vs. 8. 0（3, 9）, 5.5（0, 9） vs. 7.0（2, 9）, 2. 0（0, 8） vs. 3.0（0, 9）, 3.0（0, 9） vs. 5.0（0, 9）, Ps 〈 0.05], and higher factor scores in conflict[ 5.0 （0, 9） vs. 2. 5 （0, 7）, P 〈 0. 05]. Binge-eating/purging type patients had higher expressiveness and intellectual-cultural orientation than those in restricting type[6. 0（1,9） vs. 5.0（0, 8）, 3.0（0, 8） vs. 2. 0（0, 7）, Ps 〈 0. 05]. The level of severity of patients in AN group could be separated into four subgroups which was based on current body mass index （BMI）. There was a statistic difference in cohesion factor among the subgroups; pairwise comparison found that both of the moderate group and extreme group had higher scores than that of severe group[7. 0（0, 9）, 8. 0（0, 9）vs. 5.5（0, 9）, Ps 〈 0. 05]. The FES-CV factor scores of cohesion, expressiveness, and active-recreation orientation were positively correlated with the SCL-90 total scores（r = -0. 39, -0. 28, -0. 22; Ps 〈0.05）, but the conflict factor was on the con- trary（r = 0. 24, Ps 〈 0. 05）. The scores of cohesion and conflict were correlated with EAT-26 total scores （ r = - 0. 24, 0. 32; Ps 〈 0. 05）. The factor scores of cohesion, expressiveness and active-recreation orientation were negatively correlated with the course of disease（r = - 0. 27, - 0. 28, - 0. 23; Ps 〈 0.05）. Conclusion： It suggests that the characteristics of family environment in patients with anorexia nervosa may be different from those of normal families, and lower cohesion may be related to worse mental symptom and eating attitude and longer course.