Why are eating disorders so hard to treat? - Anees Bahji

譯者: Yan Rong Wu 審譯者: Helen Chang

Globally, about 10% of people

全球約有10%的人，

will experience an eating disorder during their lifetime.

在其一生中會經歷飲食失調。

And yet, eating disorders are profoundly misunderstood.

然而，飲食失調被深深地誤解了。

Misconceptions about everything from symptoms to treatment,

對於從症狀到治療的一切誤解，

make it difficult to navigate an eating disorder

使人們難以理解飲食失調的問題，

or support someone you love as they do so.

或當所愛的人這麼做時，給予支持。

So let’s walk through what is— and isn’t— true about eating disorders.

因此，讓我們來看看關於飲食失調的事實 是什麼和不是什麼。

First, what is an eating disorder?

首先，什麼是飲食失調？

Eating disorders are a range of psychiatric conditions

飲食失調是一系列的精神疾病，

characterized by these main patterns of behavior:

以這些主要的行為模式為特徵：

restricting food intake, bingeing, or rapidly consuming large amounts of food,

限制飲食的攝入或暴飲暴食，

and purging or eliminating calories

還有透過嘔吐、瀉藥、過度運動 以及其他有害的方式來消除卡路里。

through vomiting, laxatives, excessive exercise, and other harmful means.

An eating disorder can involve any one or any combination of these behaviors.

飲食失調會涉及到這些行為中的 任何一個或任何組合。

For example, people living with anorexia

例如，患有厭食症的人

usually restrict the amount of food they eat,

通常會限制他們所攝取的食物量，

while bulimia nervosa is an eating disorder

而暴食症也是種飲食失調，

characterized by recurrent binges and purges.

其特徵為反覆地暴飲暴食。

Importantly, these behaviors determine whether someone has an eating disorder.

重要的是，這些行為決定了 一個人是否飲食失調。

You can’t tell whether someone has an eating disorder

你無法單從體重來判斷 一個人是否飲食失調。

from their weight alone.

People who weigh what medical professionals might consider

醫療專業人員所認為的健康體重範圍內，

a healthy range can have eating disorders,

也有人患有飲食失調，

including severe ones that damage their long-term health in invisible ways,

包含嚴重的，以看不見的方式 損害他們長期的健康，

including osteoporosis, anemia, heart damage, and kidney damage.

包含骨質疏鬆症、貧血、 心臟及腎臟損害。

Just as we can’t tell whether someone has an eating disorder

如同我們無法單憑體重 判斷一個人是否飲食失調，

based on their weight alone,

we can’t get rid of these disorders simply by eating differently.

我們無法僅依靠不同飲食方式 來擺脫這些疾病。

That’s because eating disorders are, at their core, psychiatric illnesses.

這是因為飲食失調的核心原因 是精神疾病。

From what we understand,

根據我們所了解的，

they involve a disruption to someone’s self-perception.

這涉及到對某人自我認知的破壞。

Most people who experience them are severely critical of themselves

大部分經歷這些的人 對自我有嚴厲的批判，

and report many self-perceived flaws.

並有許多自認的缺陷。

They may use eating to try to regain some control

他們可能試著透過吃 來重獲對於內心混亂的控制權。

over an internal sense of chaos.

We still don’t know exactly what causes eating disorders.

我們依然不清楚 造成飲食失調的確切原因。

There likely isn’t a single cause, but a combination

可能不是單一的原因， 而是基因及環境風險因素結合所造成的。

of genetic and environmental risk factors that contribute.

Sometimes, other mental illnesses— like depression or anxiety—

有時，其他心理疾病， 像是憂鬱症或焦慮症，

can cause symptoms of eating disorders.

能引起飲食失調的症狀。

In addition, certain psychological factors,

除此之外，某些心理因素，

such as perfectionism and body image dissatisfaction,

像是完美主義及對身體意象不滿意，

are risk factors for eating disorders.

都是飲食失調的風險因素。

Several social factors contribute, too,

一些社會因素也有影響，

including internalized weight stigma, exposure to bullying,

包含內化的體重汙名，遭受霸凌，

racial and ethnic assimilation, and limited social networks.

種族及民族的同化，和受限的社會網絡。

Although there is a common misconception that only women

雖然普遍誤解只有女性會遭遇飲食失調，

experience eating disorders,

people of all genders can be affected.

但所有性別的人都可能受到影響。

As these disorders intimately affect the development

由於這些疾病密切地影響著

of one’s identity and self-esteem,

一個人特性及自尊的發展，

people are particularly vulnerable to developing them during adolescence.

人們在青春期時特別容易患上這些疾病。

Although these are among the most challenging

雖然這些精神疾病的治療最具挑戰性，

psychiatric disorders to treat,

effective therapies and interventions exist,

但仍存在著有效的治療方法和干預措施，

and many people who receive treatment make a full recovery.

而且許多接受治療的人能完全恢復。

Treatment has a higher chance of success the earlier it starts

當某人出現不正常的飲食行為時， 越早開始治療，有越高的成功機會。

after someone develops disordered eating behaviors.

But unfortunately, less than half of people with an eating disorder

不幸的是，不到一半的飲食失調者

will seek and receive treatment.

會尋求並接受治療。

Because of the complex effects of eating disorders

由於飲食失調對身心所造成的複雜影響，

on both the body and the mind,

treatment usually includes a combination of nutritional counseling and monitoring,

治療通常結合營養諮詢和監測，

psychotherapy, and in some cases, medications.

心理治療，

以及在某些情況下，使用藥物治療。

Evidence-based psychotherapies exist as treatments for most eating disorders,

大多數飲食失調的治療 用到循證心理治療，

including cognitive-behavioral therapy and family-based therapy.

包含認知行為療法及家庭治療法。

These are talk-therapies that help people gain the skills

這些談話療法幫助人們獲得技巧

to deal with underlying psychological problems

來處理引發飲食失調症狀的 潛在心理問題。

that drive eating disorder symptoms.

Because not all patients will respond to these treatments,

由於不是所有病人都對這些治療有反應，

researchers are also investigating treatments outside of psychotherapy,

研究人員也在調查心理以外的治療方法，

such as transcranial magnetic stimulation.

例如經顱磁刺激。

Proper treatment can reduce the chances of dying from a severe eating disorder.

適當的治療可以減少 因嚴重飲食失調而死亡的機會。

Eating disorders can provoke a powerful sense of powerlessness,

飲食失調會激起強烈的無力感，

but education for individuals, families, and communities

但對個人、家庭和群體的教育

helps erode the stigma and improve access to treatment.

有助於消除汙名並改善獲得治療的機會。