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

10.30074/FJMH.201503_28(1).0001

林彥妤(Lily Yen-Yu Lin)；陳冠宇(Kuan-Yu Chen)

飲食疾患 ； 心智化 ； 自行催吐行為 ； 後青春期 ； eating disorder ； mentalization-based therapy ； purging ； binging

中華心理衛生學刊

28卷1期（2015 / 03 / 01）

1 - 18

繁體中文

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-basedtreatment, 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. It's 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.

1. Allen, J. G.(Ed.),Fonagy, P.(Ed.)(2006).Handbook of mentalization-based treatment.West Sussex, England:John Wiley & Sons.
2. American Psychiatric Association(2000).Text revision of diagnostic and statistical manual of mental disorders, DSM-IV-TR.Washington, DC:American Psychiatric Publishing.
3. Bateman, A.,Fonagy, P.(2010).Mentalization-based treatment for borderline personality disorder.World Psychiatry,9(1),11-15.
4. Blos, P.(1967).The second individualization process of adolescence.The Psychoanalytic Study of the Child,22,162-186.
5. Blos, P.(1976).When and how does adolescence end? Structural criteria for adolescent closure.Adolescent Psychiatry,5,5-17.
6. Cicchetti, D.,Rogosch, F. A.(2002).A developmental psychopathology perspectives on adolescence.Journal of Consulting and Clinical Psychology,70(1),6-20.
7. Clarkin, J. F.(Ed.),Fonagy, P.(Ed.),Gabbard, G. O.(Ed.)(2010).Psychodynamic psychotherapy for personality disorders: A clinic handbook.Washington, DC:American Psychiatric Publishing.
8. Clarkin, J. F.(Ed.),Fonagy, P.(Ed.),Gabbard, G. O.(Ed.)(2010).Psychodynamic psychotherapy for personality disorder: a clinical handbook.Washington, DC:American Psychiatric Publishing.
9. Coleman, J.(Ed.),Hendry, L.(Ed.),Kloep, M.(Ed.)(2007).Adolescences and health.West Sussex, England:Wiley.
10. Fairburn, C. G.,Bohn, K.(2005).Eating disorder NOS (EDNOS): An example of the troublesome "not otherwise specified" (NOS) category in DSM-IV.Behavior Research and Therapy,43(6),691-701.
11. Fonagy, P.,Leigh, T.,Steele, M.,Steele, H.,Kennedy, R.,Mattoon, G.,Gerber, A.(1996).The relation of attachment status, psychiatric classification and response to psychotherapy.Journal of Consulting and Clinical Psychology,64(1),22-31.
12. Fonagy, P.,Steele, M.,Steele, H.,Leigh, T.,Kennedy, R.,Mattoon, G.,Target, M.(1995).Attachment, the reflective self and borderline states: The predictive specificity of the adult attachment interview and pathological emotional development.Attachment theory: Social, developmental and clinical perspectives,Hillsdale, NJ:
13. Fonagy, P.,Target, M.(2006).The mentalization-based approach to the pathology of self.Journal of Personality Disorder,20(6),544-576.
14. Garner, D. M.(Ed.),Garfinkel, P. E.(Ed.)(1997).Handbook of treatment for eating disorders.New York, NY:Guilford.
15. Jones, C.,Leung, N.,Harris, G.(2007).Dysfunctional core beliefs in eating disorders: A review.Journal of Cognitive Psychotherapy,21(2),156-171.
16. Keel, P. K.,Heatherton, T. F.,Dorer, D. J.,Joiner, T. E.,Zalta, A. K.(2006).Point prevalence of bulimia nervosa in 1982, 1992, and 2002.Psychological Medicine,36(1),119-127.
17. Luck, A.,Waller, G.,Meyer, C.,Ussher, M.,Lacey, H.(2005).The role of schema processes in eating disorders.Cognitive Therapy and Research,29(6),717-732.
18. Moore, S.(Ed.),Rosenthal, D.(Ed.)(2006).Sexuality in adolescence: Current trends.East Sussex, England:Routledge.
19. Nicholi, A. M.(Ed.)(1988).The new Harvard guide to psychiatry.Cambridge, Massachusetts:Harvard University Press.
20. Perl, E.(2008).Psychotherapy with adolescent girls and young women: Fostering autonomy through attachment.New York, NY:Guilford.
21. Peterson, M.(2005).Assessment of eating disorders.New York, NY:Guilford.
22. Robinson, P.,Barrett, B.,Bateman, A.,Hakeem, A.,Hellier, J.,Lemonsky, F.,Fonagy, P.(2014).Study protocol for a randomized controlled trial of mentalization based therapy against specialist supportive clinical management in patients with both eating disorders and symptoms of borderline personality disorder.Biomed Central Psychiatry,14(51),1-10.
23. Safer, D. L.,Couturier, J. L.,Lock, J.(2007).Dialectical behavior therapy modified for adolescent with binge eating disorder: A case report.Cognitive and Behavioral Practice,14(2),157-167.
24. Skårderud, F.(2007).Eating one's words: Part II: The embodied mind and reflective function in anorexia nervosa-Theory.European Eating Disorder Review,15(4),243-252.
25. Skårderud, F.(2007).Eating one's words: Part I: 'Concretised metaphors' and reflective function in anorexia nervosa-An interview study.European Eating Disorder Review,15(3),163-174.
26. Skårderud, F.(2007).Eating one's words: Part III. Metalization-based psychotherapy for anorexia nervosa-An outline for a treatment and training manual.European Eating Disorder Review,15(5),323-339.
27. Steiner, H.(Ed.)(1996).Treating adolescents.San Francisco, CA:Jossey-Bass.
28. Stern, T. A.(Ed.),Fricchione(Ed.),Cassem, G. L.(Ed.),Cassem, N. H.(Ed.),Jellinek, M. S.(Ed.),Rosenbaum, J. F.(Ed.)(2010).Massachusetts General Hospital handbook of general hospital psychiatry.Philadelphia, PA:Saunders Elsevier.
29. Tereno, S.,Soares, I.,Martins, C.,Celani, M.,Sampaio, D.(2008).Attachment styles, memories of parental rearing and therapeutic bond: a study with eating disordered patients, their parents and therapist.European Eating Disorder Review,16(1),49-58.
30. Thompson, J. K.(Ed.)(2004).Handbook of eating disorders and obesity.Oxford, England:John Wiley & Son.
31. Wolfe, E. A.(Ed.),Mash, E. J.(Ed.)(2006).Behavioral and emotional disorders in adolescents.New York, NY:Guilford.
32. Zerbe, K. J.(1993).The body betrayed: A deeper understanding of women, eating disorders, and treatment.Washington, DC:American Psychiatric Publishing.
33. Zweig, R. D.,Leahy, R. L.(2012).Treatment plans and interventions for bulimia and binge-eating disorder.New York, NY:Guildford.
34. 柯永河(2001)。習慣心理學—辨識篇。臺北:張老師文化事業公司。
35. 陳冠宇、林亮吟、陳喬琪、胡維恆(2000)。某高中職學生的暴食症盛行率。臺灣精神醫學，14(4)，27-37。

1. 游勝翔,王治凱(2018)。台灣大學生之偏差飲食行為及其預測因子探討。臨床心理學刊，12(1/2)，53-74。
2. 張鈞弼,吳怡珍,刑志彬(2019)。個案研究方法在心理治療實務研究之應用與回顧。輔導季刊，55(2)，34-43。
3. (2016)。依附理論於青少年諮商中的應用。教育研究月刊，264，52-69。