Oyendetsa Maganizo a Kuthandizira Kudya Kwambiri (2019)

Kudalirika

Kukhwima maganizo ndi chinthu chofunika kwambiri cha matenda osokoneza bongo, omwe amagawana kwambiri ndi kudya kwambiri mobwerezabwereza ngakhale atakhala ndi zotsatira zoipa. Mchitidwe wodya kudya ndizosiyana ndi mikhalidwe yambiri yodyera, kuphatikizapo matenda ovutika [bulimia nervosa (BN), kudya zakudya zolimbitsa thupi (BED)], kunenepa kwambiri, ndi kuledzera kwa chakudya (FA). Kumangokhalira kukakamizidwa kumayendetsedwa ndi zigawo zinayi zosiyana siyana zomwe zimagwirizana, zomwe zimagwirizana ndi zochitika zokhudzana ndi chidziwitso, zomwe zimagwira ntchito / kusinthasintha, kusasamala / kusokoneza chidziwitso ndi kuphunzira chizolowezi. Komabe, sizikudziwikiratu ngati khalidwe lobwerezabwereza m'zochitika zogwirizana ndi kudya zikutsitsimutsidwa ndi zoperewera m'zigawo zikuluzikulu zamaganizo. Kufufuza kwadzuwa komweku kumapangitsa umboni womwe ulipo kuti ugwire ntchito zokhudzana ndi kukakamiza zokhudzana ndi kukhudzidwa kwa chidziwitso chilichonse pakati pa anthu ndi khalidwe lodya kwambiri. M'madera anayi adzilankhulo, mwachitsanzo, kusinthika, kusamalidwa ndi kuphunzirira chizolowezi, zofufuza zinasakanizidwa. Umboni wochulukirapo umatanthawuzira kuwonongeka kosavomerezeka kokhudzana ndi mikangano yokha chifukwa cha kunenepa kwambiri komanso kuwonongeka kwachinyengo ndi kutaya magazi. Zowonjezereka, zomwe zapeza pa maphunziro opitilirapo zikuthandizira lingaliro lakuti zoperewera zokhudzana ndi kukhudzidwa ndi kukakamiza zimakhala zofala pazochitika zosiyanasiyana zokhudzana ndi kudya, ngakhale kuti umboni unali wosagwirizana kapena wosowa chifukwa cha zovuta zina. Timakambirana zofunikira zenizeni komanso zothandiza za zotsatirazi, komanso zomwe zimatithandiza kumvetsetsa za kukhudzidwa ndi zovuta zomwe zimakhudzana ndi kudya.

Keywords: kukakamiza, kumvetsetsa, khalidwe la kudya, kunenepa kwambiri, bulimia nervosa, kudya mowa, kudya zakudya

Introduction

Kukhwima maganizo kumatanthawuza kuti "ntchito yobwerezabwereza, yosafunidwa komanso yowonongeka bwino kapena yowonongeka popanda kuchita zinthu zowonongeka, kuchita mwambo wokhazikika kapena wosasinthika, malinga ndi malamulo okhwimitsa kapena njira zopewa zotsatira zolakwika" (Fineberg et al. , , p. 70). Makhalidwe abwino odyera kudya, omwe amadziwika ngati kubwereza, osakhala ndi homeostatic ntchito, ndi zotsatira zovuta, komanso njira zothandizira kuti asamakhale ndi nkhawa, amapezeka m'madera osiyanasiyana (Moore et al., ). Izi zikuphatikizapo: (1) matenda monga bulimia nervosa (BN) ndi matenda oledzera (BED); (2) kunenepa kwambiri; ndi (3) zakudya zolimbitsa thupi (FA), zomwe zimakhala zosiyana kwambiri ndi zofufuza (Table ​(Table1).1). Komabe, nkofunika kuvomereza kuti kuvomereza kwa FA ndi mfundo yotsutsana kwambiri ndi yotsutsana pakati pa asayansi (Ziauddeen ndi Fletcher, ; Hebebrand et al., ; Cullen et al., ). M'nkhani yowonongekayi, timayang'ana zokhudzana ndi zovuta za matendawa. Kuti tichite zimenezi, timagwiritsa ntchito zigawo zinayi zomwe zimagwiritsidwa ntchito pokakamizidwa ndi Fineberg et al. (; kutanthauza kusamvetsetsa, kusamalidwa, kunyalanyaza, kuphunzirira chizolowezi), ndi maphunziro openda omwe amayeza gawo limodzi mwa akuluakulu omwe ali ndi BN, BED, kunenepa kwambiri kapena FA. Kuti tiwonetsetse nthawi yake, tangopenda kafukufuku wofalitsidwa m'zaka zapitazi za 5 (chifukwa cha ndemanga za ntchito yam'mbuyo m'madera osiyana awona: Wu et al., ; Stojek et al., ).

Gulu 1

Zochitika zachipatala za bulimia nervosa (BN), matenda osokoneza bongo (BED), kunenepa kwambiri, ndi kuledzera kwa zakudya (FA).

Bulimia nervosa (BN)Matenda odyera kudya (BED)kunenepaChizoloŵezi cha zakudya (FA)
  1. Mipingo yambiri yozoloŵera kudya (BE) omwe amadziwika ndi: (a) kudya m'kati mwa nthawi ya 2 kuchuluka kwa chakudya chokwanira kusiyana ndi zomwe anthu ambiri amadya nthawi yofanana; ndipo (b) lingaliro la kusowa kwa mphamvu kudya kwambiri panthawiyi
  2. Zochitika zosayenera zosayenera kuti athetse kulemera, monga kusanza kudzipangitsa kudzipangira, kugwiritsa ntchito molakwa mankhwala ophera mankhwala, diuretics, kapena mankhwala ena, kusala kudya, kapena kuchita masewera olimbitsa thupi.
  3. Kudya mowa ndi zoyenera zolakwitsa zimakhala zochitika, pafupifupi, kamodzi pa sabata kwa miyezi 3.
  4. Kudzifufuza kumakhudzidwa kwambiri ndi mawonekedwe a thupi ndi kulemera kwake.
  5. Chisokonezo sichipezeka pokhapokha pazigawo za Anorexia Nervosa.
  1. Zigawo zatsopano za BE omwe amadziwika ndi: (a) kudya m'kati mwa nthawi ya 2 kuchuluka kwa chakudya chokwanira kusiyana ndi zomwe anthu ambiri amadya nthawi yofanana; ndipo (b) lingaliro la kusowa kwa mphamvu kudya kwambiri panthawiyi
  2. ZINTHU zimagwirizanitsidwa ndi zizindikiro zitatu zotsatirazi:
    1. Kudya mofulumira kwambiri kuposa mwachibadwa
    2. Kudya mpaka kumverera mokwanira bwino
    3. Kudya chakudya chochuluka pamene sichimva njala yakuthupi
    4. Kudya nokha chifukwa chochita manyazi
    5. Kumadzimvera chisoni, kudzipsinjika, kapena kukhala ndi mlandu pambuyo pake
  3. Dandaula za BE
  4. KUKHALA kumachitika, pafupifupi, kamodzi pa sabata kwa miyezi 3
  5. Khalani osagwirizana ndi kugwiritsa ntchito kosavomerezeka kosayenera (mwachitsanzo, kuyeretsa) ndipo sikuchitika pokhapokha pa Bulimia Nervosa kapena Anorexia Nervosa.
Thupi la misala ya thupi ((BMI) = kulemera kwa thupi (kg) / kutalika (m2) ≥30 BMI 30-39 = yambiri
BMI ≥40 = yochuluka kwambiri

  1. Kudya mopitirira muyeso, mwachitsanzo, kudya kwambiri kalori wokhudzana ndi kugwiritsa ntchito mphamvu
  1. Zosokoneza zambiri kuposa zomwe zinakonzedweratu (kuchuluka kwa ndalama ndi kwa nthawi yaitali)
  2. Simungathe kudula kapena kuimitsa
  3. Kugwiritsa ntchito nthawi yaikulu
  4. Ntchito zofunikira zoperekedwa kapena zochepa
  5. Gwiritsani ntchito ngakhale mutadziwa zotsatira za thupi / zowawa
  6. Kupirira (kuonjezera kuchuluka, kuchepa kwenikweni)
  7. Kuchotsa (zizindikiro, mankhwala otengedwa kuti athetse kuchotsa)
  8. Kulakalaka kapena chikhumbo cholimba
  9. Kulephera udindo
  10. Gwiritsani ntchito mosasamala kanthu za zotsatira zake / zokhudzana ndi chikhalidwe
  11. Gwiritsani ntchito mkhalidwe woopsa

Zindikirani: Zizindikiro za BN ndi BED zimatanthauzidwa malinga ndi njira za matenda a DSM 5 (American Psychiatric Association, ). Magulu a BMI otchulidwa mogwirizana ndi World Health Organization (). Zizindikiro za FA zikufotokozedwa molingana ndi zomwe Gearhardt et al adachita. (). Mndandanda wa Bold umatanthauzanso makhalidwe omwe amakwanira kuti munthu asamangokhalira kudya phenotype (ie, mobwerezabwereza amayamba, popanda kusintha-homeostatic ntchito ndi / kapena kutsogoleredwa ndi nkhawa).

Ndemanga ya Zotsatira

M'chigawo chino, timatanthauzira zigawo zonse zokhudzana ndi kukakamizidwa ndi ntchito zomwe zimawayeza, ndikuwonanso umboni wa ntchitoyi: (1) BN ndi BED; (2) kunenepa kwambiri; (3) FA; ndi (4) zomwe zimagwirizanitsa (mwachitsanzo, kunenepa kwambiri ndi BED; kunenepa kwambiri ndi FA). Chithunzi ​Chithunzi11 amasonyeza mwachidule cha zomwe apeza.

Fayilo yakunja yomwe imagwira chithunzi, fanizo, ndi zina. Dzina lake ndi fnbeh-12-00338-g0001.jpg

Umboni wokhudzana ndi kukakamira komwe kumakhudzana ndi kukakamira pazinthu zokhudzana ndi kudya: bulimia nervosa (BN), vuto la kudya kwambiri (BED), kunenepa kwambiri (OB), komanso kusuta (FA). Mitundu imawonetsa kuwongolera kwa umboniwo, wobiriwira: umboni wosasinthasintha wazoperewera; lalanje: umboni wosagwirizana (pafupifupi 50% yamaphunziro akuwonetsa zoperewera / kusowa kwa zoperewera); zofiira: umboni wopanda umboni = palibe zoperewera (zosonyezedwa ndi> 60% yamaphunziro); Strikethrough imvi: palibe maphunziro omwe alipo. Zolemba pamanja zikuwonetsa kuchuluka kwa maphunziro pachinthu chilichonse chazidziwitso komanso vuto.

Kulimbitsa Maganizo Okhudzana ndi Zosagwirizana

Chigawo ichi chimatanthawuza "kusalakwitsa kusintha kwa khalidwe pambuyo pazolakwika" (Fineberg et al., ). Zakhala zikuchitika kuti kukakamizidwa kumabwera chifukwa cholimbikira pa khalidwe lomwe laperekedwa kale, koma kenaka limakhala ndi zotsatira zovulaza, kusonyeza kusamvetsetsana pang'ono. Kusintha kwa chidziwitso chokhudzana ndi zochitika zokhudzana ndi zochitika zakale kawirikawiri kunayesedwa pogwiritsa ntchito ntchito yovuta yophunzirira yolakwika (PRLT; Cools et al., ; Clarke et al., ), zomwe zimaphatikizapo kusankha pakati pa ziphunzitso ziwiri ndi kuphunzira zomwe nthawi zambiri zimapindula (zotsatira zabwino), pamene zina zimalangidwa (zotsatira zoipa). Ulamulirowo umasintha ndipo ophunzira akuyenera kusintha khalidwe lawo poyang'ana kusintha kosintha.

Ngakhale kuti palibe kafukufuku amene adafufuzapo mbaliyi mu BN, BED yokha kapena FA, zidziwitso zowonongeka zakhala zikuwonetsedwa mu kunenepa kwambiri. Mwachindunji, anthu omwe ali ndi kunenepa kwambiri adawonetseratu zovuta zambiri poletsa chikhalidwe choyambirira cha kuphunzira chomwe chimawonetsedwa ndi zolakwitsa zowonjezera ku Rule Shift Cards task (Spitoni et al., ). Akazi omwe ali ndi kunenepa kwambiri adasonyezanso zoperewera zomwe ophunzira amaphunzira, koma osati ndalama (Zhang et al., ). Zotsutsana zowonjezereka zakhala zikufotokozedwanso, momwe ophunzira omwe ali ndi kunenepa kwambiri amasonyeza chilango chopweteka, koma osati mphotho yophunzira yokhudzana ndi kulamulira bwino (Coppin et al., ; Banca et al., ), pamene owonjezera omwe ali ndi BED akuwonetsa mphotho yopanda malipiro, koma samapereka chilango pophunzira kwa omwe alibe BED (Banca et al., ).

Ntchito / Yoganizira Yokonza-Kusintha

Chigawo ichi chimatanthauzidwa ngati "kusinthasintha kwachisamaliro pakati pa zokhumudwitsa" (Fineberg et al., ). Zimaphatikizapo kusinthasintha nthawi zambiri pakati pa ntchito kapena mawonekedwe, zomwe zimafuna kuwonetsa miyeso yambiri ya zolimbikitsa. Zindikirani, kuyika-kusunthira kumakhalanso zofanana, komabe zimadalira kuchitapo kanthu-kuyankha m'malo mwa mphotho ndi zotsatira za chilango. Njira zowonongeka zowonongeka zinali Wisconsin Card Sorting Test (WCST) ndi Ntchito Yopanga Trail-B (TMT-B), pomwe ntchito ya Intra-Dimensional / Extra-Dimensional-shift shift (Robbins et al., ) ndi Paradigm ya Kusintha Ntchito (Steenbergen et al., ) anagwiritsidwa ntchito mobwerezabwereza. WCST ikuphatikiza kufanana ndi khadi ndi zinthu zina (mwachitsanzo, mtundu, mawonekedwe) kwa imodzi mwa makadi ena anayi pogwiritsa ntchito "malamulo ofanana," omwe amasintha nthawi yonseyi. Mu TMT-B, ophunzira akufunsidwa kujambula mzere wolumikiza manambala ena ndi makalata (mwachitsanzo, 1-A-2-B-3-C).

Kafufuzidwe kafukufuku wokhudzana ndi kusinthika akugwiritsidwa ntchito pazovuta za kudya. Kafukufuku wina adapeza kuti kusinthika sikunali kovuta ku BN (Pignatti ndi Bernasconi, ), BED (Manase et al., ), kapena m'munsimu zizindikiro za BE (Kelly et al., ). Komabe, Kelly et al. () anapeza kuti chiwerengero cha zigawo zolimbitsa thupi zinagwirizanitsidwa bwino ndi zolakwitsa zowonjezera pa WCST (mwachitsanzo, kusasunthika). Kuwonjezera pamenepo, maphunziro ena anapeza osayenerera kusintha kwa odwala omwe ali ndi BED kapena BN wokhudzana ndi kulamulira bwino (Goddard et al., ; Aloi et al., ).

Pofuna kunenepa kwambiri, kufufuza kuyesa kusinthika kwapangitsa kuti zotsatira zisagwirizane. Mwachidziwitso, maphunziro ena sanapeze umboni wosagwira ntchito (Chamberlain et al., ; Fagundo et al., ; Manase et al., ; Schiff et al., ; Wu et al., ), pamene kufufuza kwina kunapezako kusintha kwa anthu omwe ali ndi vuto lolemera kwambiri kapena kunenepa kwambiri pokhudzana ndi kulamulira bwino (Gameiro et al., ; Steenbergen ndi Colzato, ) komanso kudya odwala matenda (Perpiñá et al., ). Zofukufuku zawonetsanso kusokonekera kwa anthu omwe ali ndi BED, koma osati omwe alibe (Banca et al., ), ndipo amalepheretsa ophunzira omwe ali ndipamwamba, koma osati otsika FA zizindikiro (Rodrigue et al., ).

Zosamala / Kutaya Maganizo

Chigawo ichi chimaphatikizapo "kusinthasintha kwa maganizo kusokonezeka" (Fineberg et al., ). Ndalama zowonongeka zimaphatikizapo kuwonetsa zokhazokha; mbali yowonetsera chidwi (Cisler ndi Koster, ), pamene kusokonezeka kumatanthawuza kuti sitingathe kuwatsogolera / kusuntha kuchoka ku zovuta zoterozo, zomwe zingachititse kuti munthu asamangokhalira kuchita zinthu molakwika kudzera kusagwedezeka kochitidwa ndi zovuta zokhudzana ndi matenda (Fineberg et al., ). Zochita zowonongeka nthawi zambiri zimayesedwa ndi Visual Probe Task (VPT), ​​momwe ophunzira amauzidwa kuti ayankhe dontho lomwe likuwonekera kumanzere kapena kumanja kwa makanema kamodzi potsatira chiwonetsero cha stimuli, kapena Emotional Stroop , momwe ophunzira akufunsidwa kutchula mtundu wa inki wa mawu olembedwa ponyalanyaza zomwe zili.

Maphunziro angapo apereka umboni wokhudzana ndi zakudya zopanda thanzi ku BN (Albery et al., ), BED (Sperling et al., ), kapena kugonjetsa zizindikiro za BE (Popien et al., ), ngakhale kuti kafukufuku wina waposachedwapa sanapeze umboni wonyalanyaza chakudya chodetsa nkhaŵa mu BED kapena BN poyendetsa bwino kulemera kwabwino (Lee et al., ). Kafukufuku wina awonetsanso chidwi cha chakudya chosafunika kwambiri poyerekeza ndi odwala olemera (Kemps et al., ; Bongers et al., ), pamene kafukufuku wina sanapeze mgwirizano pakati pazinthu zamakono ndi mawu okhudzana ndi kunenepa kwambiri (chiwerengero cha mthupi, BMI ndi mafuta a m'mimba). Komabe, anthu ovutika kwambiri omwe ali ndi BED amasonyeza chidwi chokwanira pa zakudya zopanda thanzi kusiyana ndi omwe alibe BED kapena kuchepetsa kulemera (Schag et al., ; Schmitz et al., , ), komanso anthu omwe ali ndi kunenepa kwambiri komanso zizindikiro zowonjezera zizindikiro zimakhala zovuta kwambiri kusiyana ndi omwe alibe BE (Deluchi et al., ). Ophunzira omwe anali ndi kunenepa kwambiri ndi FA anali ndi chidwi chochuluka kwambiri komanso zovuta kwambiri kuchotsa zakudya zopanda thanzi zokhudzana ndi kulemera kwapadera popanda FA (Frayn et al., ).

Chizolowezi Kuphunzira

Cholinga ichi chikuphatikizapo "kusowa chidwi pa zolinga kapena zotsatira za zochita" (Fineberg et al., ). Zophatikizapo zaphunziro zokhudzana ndi khalidwe lachidziwitso kuti zochitazo zimagwiridwa ndi machitidwe awiri: cholinga-chotsogolera ndi kachitidwe kachitidwe (Balleine ndi Dickinson, ; de Wit ndi Dickinson, ). Kukhwima maganizo kumaphatikizapo kuchoka pa kuchoka kuchoka ku cholinga-chotsogolera kuchita ku chizolowezi chifukwa cha kusayenerera m'magwiridwe awiriwa, mwachitsanzo, cholinga cholakwika-chotsogoleredwa kapena chizolowezi chochita zinthu mopitirira malire. Umboni wosagwirizana pakati pa machitidwe awiriwa ukhoza kuyesedwa ndi mapangidwe opanga zisankho. Muzochita zowonetsera zowonjezereka, ophunzira ayenera kupeŵa kuyankhapo pamene mphotho zawo zogwirizana nazo zatsimikiziridwa mwa kusintha kusintha kwa zotsatira zomwe zikuchitika mu Slips-of-Action task (de Wit et al., ) kapena satiety (Balleine ndi Dickinson) ). Ntchito ya awiri-Stage imagwiritsa ntchito njira yopanda ntchito yopangira maphunziro yomwe anthu amauzidwa kuti apange zosankha mogwirizana ndi zisankho zowonjezereka (zosiyana-siyana, "chizolowezi" chofanana) "Zolinga-zolangizidwa;" Daw et al., ).

Zotsatira kuchokera ku maphunziro pa chizoloŵezi chophunzira kuwonjezera kunenepa ndi zosiyana. Kafukufuku wapadera, kafukufuku awiri wasonyeza kuti anthu omwe ali ndi kunenepa kwambiri sankamvetsetsa zotsatira za zotsatira, mwachitsanzo, kuyendetsa kayendetsedwe ka ntchito kunasinthidwa ku chizoloŵezi choyendetsa bwino ndi kutali ndi cholinga chotsogolera zolinga, zomwe zimasonyeza kuti machitidwe awiriwa ndi osagwirizana (Horstmann et al., ). Mosiyana ndi zimenezi, maphunziro ena awiri pogwiritsa ntchito ntchito ya Slips-of-Action anapeza kuti ophunzira omwe ali ndi kunenepa kwambiri sanapangitse zowonjezereka kuposa odwala olimba (Dietrich et al., ; Watson et al., ). Komabe, kafukufuku wina adawonetsa kuti anthu olemera kwambiri omwe ali ndi BED amasonyeza kuwonongeka kwakukulu muzolowera zolinga (zosiyana-siyana) kusiyana ndi mayankho omwe sakhalapo (osakhala opanda pake) kusiyana ndi anthu ochepa omwe alibe BED kapena ochita zowononga bwino (Voon et al., ).

Kukambirana

Kuwunika kwathu kukuwonetsa umboni wina wa zoperewera pazinthu zinayi zomwe zimagwirizanitsa anthu omwe ali ndi mavuto okhudzana ndi kudya. Komabe, pazifukwa zambiri zogwirizana ndi kudya (kupatulapo vuto lokwanira, kutanthauza kuti kunenepa kwambiri ndi BED) deta siidali yeniyeni ponena za kuwonongeka kwa madera ozindikira. Zomwe zikutsutsanazi zimapangitsa kuti zikhale zovuta kufotokoza motsimikiza za udindo wa kugonjetsedwa kwa chidziwitso chokhudzana ndi kukakamiza zomwe zikuyambitsa khalidwe lovuta la kudya pazifukwa. Komabe, zofukufukuzo zimakambidwa koyamba pazomwe zimagwirizanitsa zovuta zokhudzana ndi kudya. Kenako timapereka chidziwitso chokhudzana ndi momwe zigawo zikuluzikulu zokhudzana ndi kukakamiza ziyenera kugwiritsidwa ntchito pa nkhani ya kudya, zomwe zikutsatiridwa ndi zokambirana za momwe tingapititsire patsogolo kuyesera kuti tipitirize kumvetsetsa za zidziwitso zokhudzana ndi kukakamizidwa. .

Kafufuzidwe komwe kulipo pokhudzana ndi kusokonezeka kwadzidzidzi (ie, kuphunziranso kusinthidwa) kumasonyeza chitsanzo chosasinthika cha zotsatira, zomwe zimapangitsa kuti munthu asamaphunzire molakwika ndi kulemera kwambiri komanso BED. Komabe, panali kusiyana pakati pa chidziwitso cha maphunziro osokoneza maganizo (ie, mphotho ndi chilango), zomwe zinali zosiyana pazochitika (ie, kunenepa kwambiri kapena kunenepa kwambiri ndi BED). Zomwe angapereke pazifukwa zosokoneza ndizakuti anthu olemera kwambiri omwe ali ndi BED akhoza kukhala okhudzidwa kwambiri chifukwa cha khalidwe lawo lopindula kale, pamene anthu owonjezera omwe alibe BED angakhale ochepa kuti asamayankhe mogwirizana ndi makhalidwe omwe poyamba adalangidwa (Banca et al., ). Lingaliro limeneli likugwirizanitsidwa ndi chidziwitso cha kuwonjezeka kwachisomo kuti lipindule ndi chiopsezo chowonjezeka chokhudzana ndi kupereka malipiro kwa anthu ovuta kwambiri ndi BED, koma osati omwe alibe (Voon et al., ). Komabe, zofukufukuzi sizikugwirizana ndi lingaliro lonse kuti BED imalimbikitsidwa ndi njira zosalimbikitsa (Vannucci et al., ). Komabe, tawonetseratu kuti BED imadziwika ndi kuwonongeka kwachidziwitso kwa kusintha kwa chidziwitso (Voon et al., ). Choncho, kufufuza kwina kuli kofunika kuti titsegule gawo la kuphunzira mobwerezabwereza mu kunenepa kwambiri ndi BED. Pomalizira, panalibe umboni wosinthika wophunzira mwa anthu omwe ali ndi BN kapena FA, ndipo motero, zofukufukuzo ndizochepa kwa anthu omwe ali ndi BED kapena opanda BED.

Pogwiritsa ntchito ntchito / kusinthasintha, zofukufuku zinawonetsanso zotsatira zosiyana, zomwe zingakhale zosiyana ndi zosiyana siyana zachitsanzo (mwachitsanzo, zaka ndi BMI) ndi njira (mwachitsanzo, kudzidzidzimutsa ndi kuyesedwa BE; ntchito zosiyana siyana zomwe zimagwiritsidwa ntchito kuti muyese luso losinthika). Mwachitsanzo, ntchito ya ID / ED ikufunsidwa kuti iwonetsere zigawo zingapo zowakakamiza, zomwe zimapangitsa kuti aphunzire ndikusintha (Wildes et al., ), pamene njira za TMT-B zikhoza kukhazikitsidwa zokha. Chomwe chingathe kufotokozera zovuta zopezeka m'mabukuwa ndi chakuti anthu omwe ali ndi vuto la kudya kapena kunenepa kwambiri angasonyeze zoperewera m'magulu ena a zigawo za kusinthika (mwachitsanzo, kulowerera ndikutsutsana ndi ntchito), koma osati ena (mwachitsanzo, , kusunga ntchito yoyenera pa intaneti mukugwira ntchito kukumbukira). Choncho, mbali zosiyanasiyana zomwe zimagwira ntchito zosiyanasiyana zomwe zimagwiritsidwa ntchito pa maphunziro angapangitse zotsatira zotsutsana ndi izi. Mogwirizana ndi lingaliro limeneli, kufufuza kwa meta posachedwapa kwawonetsa kukula kwazing'ono zochepa za kukula kwa kusinthika kosasinthika mu BN, BED ndi kunenepa kwambiri (Wu et al., ), zomwe zikutanthauza kuti zinthu zina zingagwirizane ndi kusinthika kuti zidziwitse makhalidwe ovuta kudya. Takambirana pamodzi, ndemanga yathu komanso ndemanga ya Wu et al. () amasonyeza kuti kusayenerera kosagwiritsidwa ntchito ndi chinthu chimodzi chodziwitsidwa chokhudzidwa chomwe chingabweretse chizolowezi chodyera.

Zomwe zapezeka pa ndemangayi zimaperekanso umboni wokhudzana ndi chisokonezo cha matenda osokoneza bongo, mwachitsanzo, zakudya zopanda thanzi, mu BED, kunenepa kwambiri, ndi BED ndi kunenepa kwambiri, ngakhale kuti sikuti maphunziro onse adawonetsa izi, zomwe zikugwirizana ndi ndemanga yaposachedwapa kusankhana mwachangu m'mabvuto okhudzana ndi BE (Stojek et al., ). Komabe, panali kusiyana kwakukulu pakati pa ntchito zomwe zimagwiritsidwa ntchito poyang'ana zowonongeka, mwachitsanzo, Chisokonezo cha Emotional or VPT, chomwe chimatha kusiyanitsa pakati pa zofuna zapamwamba ndikulephera kusokoneza. Kuwonjezera apo, ntchito ya Stroop imafuna ntchito zazikulu kupatulapo zowonongeka, kuphatikizapo kuletsa kuletsa (Balleine ndi Dickinson, ; de Wit ndi Dickinson, ), motero, kukondera kungagwirizane ndi chizoloŵezi chokakamiza mosiyana kwambiri ndi zigawo zina zamaganizo. Kafukufuku wowerengeka sanawonetsere kusasamala / kusokoneza maganizo mwa BN kapena FA, yomwe idakonzedwanso muzokambirana ndi Stojek et al. (). Choncho, kafukufuku wamtsogolo ayenera kugwiritsa ntchito ntchito zomwe zimayang'anitsitsa chisamaliro ndi kusokoneza maganizo kuchokera ku matenda omwe amachititsa kuti anthu azidya zakudya zambiri.

Ntchito zomwe zimagwiritsidwa ntchito pofufuza kachitidwe ka chizolowezi zimasonyezeranso kufooka kwa kunenepa kwambiri ndi BED, ngakhale kuti maphunzirowa m'madera amenewa anali ochepa kwa anthu awiriwa odyera. Kupeza kuti kuyeserera kwa chizoloŵezi cha kuphunzira chizolowezi kunayesedwa wopanda zoyenera zotsutsana ndi ntchito zowonetsera zowonongeka, koma osati ntchito yowonongeka ikusonyeza kuti ntchito izi zingathe kuyeza mbali zosiyanasiyana za kuphunzira chizoloŵezi. Mwachitsanzo, khalidwe lingakhale chifukwa cha cholinga chosokonekera-dongosolo lotsogolera kapena chizoloŵezi chozoloŵera chizoloŵezi, chomwe chingadziwike pogwiritsa ntchito ntchito ya Two Stage (Voon et al., ). Kuwonjezera apo, mtundu wa kuthekera kwa chiyeso muzochita zinthu zowononga. Chifukwa cha kuchepa kwokhudzana ndi kunenepa kwamtundu wa umoyo wa m'mimba (Herbert ndi Pollatos, ), chiwerengero cha zotsatira kudzera satiation (Horstmann et al., ) sizingakhale zosavuta kuposa chiwerengero cha zotsatira kudzera malangizo kwa anthu olemera kwambiri / obese (Dietrich et al., ; Watson et al., ). Ngakhale kuti umboni wokhala ndi chizoloŵezi chophunzira chizoloŵezi unali wochuluka kwambiri ku BED kusiyana ndi kunenepa kwambiri, maphunziro ambiri amafunika kuti zisanachitike.

Zolepheretsa ndi Zotsatira Zotsatira za Kafukufuku

Kuwunika kwathu kukuwonetseratu ntchito yomwe ikugwiritsidwa ntchito pamaganizo, koma zakhazikika pamaganizo a kudya phenotype, zomwe zidakali zophatikizidwa mu chidziwitso chokakamizika. Mwapadera, sizikuwonekeratu momwe njira zosalimbikitsira zowonjezera (ie, kusadya maganizo) kapena kuchepetsa zakudya ndi nkhawa zowonjezereka / zolemetsa, zomwe zimayambitsa kudya kudya mu BN, BED ndi kunenepa kwambiri, zingagwirizane ndi zigawo zomwe zimagwiritsidwa ntchito ndi Fineberg et al . (). Kafufuzidwe pa maphunziro ozoloŵera amasonyeza kuti kukhala pakati pakati pa chizolowezi ndi cholinga-kuyendetsedwe kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka mankhwala kungadalire pazifukwa monga nkhawa (Schwabe ndi Wolf, ), pamene kusinthika kwasinthika kumayendetsedwa ndi nkhawa (Billingsley-Marshall et al., ), komanso kudera nkhawa za zakudya zopanda thanzi zimayesedwa ndi kudya (Hepworth et al., ). Kafukufuku wamtsogolo ayenera kuyesa ngati kudya ndi nkhawa / nkhawa / mgwirizano zimagwirizanitsa ndi zovuta zokhudzana ndi kukhudzidwa ndi chilakolako chokhudzidwa kuti zitsimikizire kuti munthu akudwala matenda osokoneza bongo.

Zopeka, zofukufuku zomwe zikuchitika panopa zimakhudzidwa ndi kumvetsa kwathu tsopano za vuto la kudya. Makamaka, vuto la kudya, lomwe ndi BN, ndi BED, limatengedwa ngati matenda a maganizo, pamene kunenepa kwambiri kumakhala ngati chikhalidwe cha thupi. Tikapeza kuti vuto la kudya ndi kunenepa kwambiri zimagwirizana ndi kusintha kwachidziwitso komwe kumagwirizana ndi kukakamizidwa kumagwirizana ndi lingaliro lakuti kunenepa kwambiri kungakhale bwino kumalingalira monga matenda okhudzidwa ndi matenda omwe amadziwika ndi mavuto aumoyo komanso aumphawi, amalingaliro ndi amakhalidwe omwe alipo pambali ya matenda osowa zakudya (Volkow ndi Wanzeru, ; Wilson, ). Komabe, tiyenera kukumbukira kuti kunenepa kwambiri ndi matenda osokoneza bongo, komanso kuti "phenotype" yodetsa nkhawa, yomwe imadziwika ndi kubwerezabwereza, popanda homeostatic ntchito, ndi zotsatirapo zovuta, komanso njira zothandizira kuthetsa nkhawa, koma si anthu onse ndi kulemera kwakukulu. Kuwonjezera apo, sitinaphatikizepo maphunziro pa zovuta zonse zomwe zimakhala ndi zovuta kudya (mwachitsanzo, BE / purging mtundu Anorexia Nervosa (AN) kapena Other Specified Kudyetsa kapena Eating Matenda, Purging Matenda, kapena Night Eating Syndrome). Komabe, kulowerera kwathu kwa zovuta kumagwirizana ndi ndemanga zaposachedwa za chilakolako chokhalitsa ngati chinthu chachikulu cha matenda enaake (ie BED), kunenepa kwambiri, ndi lingaliro lodziwika la FA (Moore et al., ). Kuonjezerapo, ndemangayi inangoganizira za momwe mungagwiritsire ntchito malingaliro awo, choncho, ngakhale pali njira zowonongeka za neural ndi khalidwe zomwe zakhudzana ndi kukakamizidwa pazochitika zosiyanasiyana zokhudzana ndi kudya siziyenera kutsimikiziridwa. Zowonjezera, madera anayi a chidziwitso a kukakamiza akufunsidwa kukhala ndi correlates yosiyana. Ngakhale kuti zinali zosiyana kwambiri ndi ndondomeko yamakono, maphunziro a m'tsogolomu amayenera kufufuza zofunikira za m'maganizo a madera omwe amadziwa bwino nkhaniyi.

Pomaliza, timaganizira momwe maphunzirowa akugwiritsidwira ntchito, kuphatikizapo kulingalira momwe kukakamiza kwakhala kudayesedwa ndikudya komanso kuchepa kwa njira zoterezi. Choyamba, ntchito zamaganizo zomwe zimagwiritsidwa ntchito pazofukufukuzo zidakongoletsedwa kuchokera kumadera ena, ndipo motero, ntchito zina zidagwiritsidwa ntchito poyesa kumanga kambirimbiri (mwachitsanzo, kulepheretsa ndi kusungunula) kapena sizinagwiritsidwe ntchito mosagwirizana. Choncho, maphunziro apamtsogolo ayenera kugwiritsira ntchito ntchito zamaganizo zomwe zimagwiritsidwa ntchito poyesa zigawo zosiyana siyana za kuumiriza. Chachiwiri, zochuluka za maphunziro omwe adawunikiridwa anawunika kusiyana pakati pa magulu (mwachitsanzo, kuchipatala ndi kulamulira bwino) pakugwirizanitsa chidziwitso chokwanira. Komabe, kafukufuku wowerengeka sanafufuze mgwirizano pakati pa ntchito ndi malingaliro oipa. Motero, kufufuza kwa m'tsogolo kumaphatikizapo kudzipangitsa kudzifunsa mafunso omwe amatha kufotokozera zochitika zapadera zomwe zimakhala zovuta kuchita, kuphatikizapo Obsessive Compulsive Eating Scale (Niemiec et al., ) kapena Cholengedwa cha Habit Scale (Ersche et al., ).

Kuwonjezera apo, panalibe maphunziro a kuyesera pa madalaivala okhudzidwa okhudzidwa ndi chilakolako chokhudzidwa ndi FA, ngakhale kuti akuganiza kuti akuganiza kuti ali ndi vuto lodziletsa kudya (Davis, ). Choncho, sizikudziwikiratu kuti zomwe zimatchulidwa kuti FA zigawanika zomwe zimagwirizanitsa ndi kugonana ndi BN, BED ndi kunenepa kwambiri. Inde, zochuluka za kafukufuku pa FA zakhala zikuyang'ana pa zizindikiro za matenda monga momwe zilili ndi YFAS; Komabe, kafukufuku wina wam'mbuyo posachedwa wakhala akunena zolakwika zochitapo kanthu (ie, go / no-go answers; Meule et al., ) ndi kusankha (ie, kuchepetsa kuchepetsa, VanderBroek-Stice et al., ) mu FA. Kafukufuku wamtsogolo ayenera kuyang'ana kukakamizidwa kugwirizanitsa chidziwitso ku FA kuti adziwe ngati izo zikudziwikiratu ndi zoperewera.

Zowonjezereka kwa zolembedwa zomwe zatsimikiziridwa ndizokuti maphunzirowa adadalira kwambiri magawo osiyana mmalo mwa mapangidwe a nthawi yaitali. Choncho, nthawi ya zidziwitso zomwe zimagwiritsidwa ntchito pokakamiza anthu okhudzana ndi kudya zikudziwikabe. Zomwe zimagwiritsidwa ntchito, zimakhala zogwirizana ndi chitukuko ndi kusungidwa kwa chizoloŵezi chodya kudya, komanso momwe zimakhalira. Mwachitsanzo, mwinamwake kuthekera kwokhoza kusinthira khalidwe pambuyo potsutsa maganizo olakwika kapena kuganizira kwambiri za zakudya zomwe zimapereka chiopsezo chowonjezeka chokhala ndi kudya mokakamiza. Mwinanso, kuchepa kwa izi kungakhale chifukwa cha kudya mokakamiza ndi kotere, komwe kumagwirizanitsidwa ndi kufotokoza kwa mikhalidwe yokhudzana ndi kudya ndi zotsatira za mankhwala. Timaganiza kuti izi ndizochitika mwamphamvu zomwe zimakhala zovuta kuti munthu akhale ndi makhalidwe osokoneza bongo omwe amatha kuwonjezereka kudzera mu njira zophunzitsira komanso zovuta. Maphunziro otsogolera komanso otsogolera a m'tsogolo ayenera kuwona ngati kukakamizidwa ndi chiopsezo, chomwe chimayambitsa kukula kwa kunenepa kwambiri kapena vuto la kudya, kapena ngati chikugwedezeka ndi kuyamba kwa zizindikiro za kuchipatala, kapena zonse ziwiri. N'kofunikanso kudziwa ngati khalidwe lovuta la kudya limasonyeza kusinthika kuchoka ku chilakolako chokakamizika, monga momwe adakonzera kuti azisokoneza (Everitt ndi Robbins, ). Kuonjezela pa mfundoyi, ndemanga yowonjezerayi ikuyang'ana pa kafukufuku omwe adawona njira zokhudzana ndi chidziwitso chokhwima, choncho sitinapendeze umboni wokhudzana ndi chidziwitso chokhudzidwa. Choncho, sizikuwonekeratu momwe zidziwitso zomwe zimayambitsa kukhudzidwa ndi kukakamizidwa zimakhudzana ndi makhalidwe okhudzana ndi kudya, kapena momwe angagwirizane ndi njira zina monga kupanga kupanga.

Malingana ndi zofooka zomwe tazitchulazi, timapereka malingaliro angapo pa kafukufuku wamtsogolo. Choyamba, kafukufuku wamtsogolo ayenera kufufuza zigawo zinayi zomwe zimagwirizanitsa chidziwitso pakati pa anthu ena (mwachitsanzo, odwala omwe ali ndi BED), m'malo mofufuza zigawo zokhazokha. Mofananamo, kufufuza kuyenera kufufuza izi zigawo zinayi zomwe zimagwiritsidwa ntchito pazomwe zimakhudzana ndi kudya, zomwe zingatilolere kudziwa ngati pali njira zomwe zimagwiritsidwa ntchito poyendetsa kayendetsedwe ka kayendetsedwe ka zakudya zoyambitsa matenda. Kuwonjezera pamenepo, zina mwazidziwitso zomwe zimagwirizanitsidwa (ie, kusintha-kusintha ndi kusinthira kuphunzira) ndizo zigawo zazing'ono zowonjezera, zowonongeka (Wildes et al., ). Choncho, zingakhale zothandiza kufotokozera zonsezi mu phunziro limodzi kuti adziwe ngati akugwirizanitsa kuti adziŵe zovuta kuchitapo kanthu pogwiritsa ntchito maulendo osiyana siyana omwe amapanga maulendo opangidwa ndi neural (Fineberg et al., ). Chofunika kwambiri, kufufuza zokhudzana ndi kukakamiza zokhudzana ndi kukakamizidwa pazinthu zosiyanasiyana zokadya pogwiritsira ntchito zojambula zomwe zingakhalepo kapena zogwiritsa ntchito nthawi zambiri zikanatha kulosera za chiopsezo chochita chizoloŵezi cha kudya. Kuonjezera apo, kufufuza kwa nthawi yaitali kungakhale ndi tanthauzo lokulitsa chitukuko cha njira zothandizira ndi njira zothandizira zothandizira kuti zikhale bwino, zomwe zingakhale njira yowonjezera kuthetsa zizoloŵezi zokhudzana ndi khalidwe lachidziwitso ku mavuto osiyanasiyana.

Kutsiliza

Zomwe anapeza pa maphunziro ena omwe amaphatikizapo amachirikiza lingaliro lakuti kukhumudwa kwa zigawo zokhudzana ndi kukakamizidwa kumagwirizanitsa zikhoza kukhala zosiyana siyana, ngakhale kuti umboniwo unali wosagwirizana kapena wosowa chifukwa cha zovuta zina. Zotsatira zosiyana mu madera ambiri zikutheka chifukwa cha ntchito zosiyana zowunikira komanso zosagwirizana ndi zakudya zokhudzana ndi zakudya, nkhawa / nkhawa, komanso kudya. Kafukufuku wamtsogolo ayenera kuyang'anitsitsa momveka bwino zigawo zomwe zimagwiritsidwa ntchito pokakamizika, kuphatikizapo zida zoyenera kudya, komanso kugwiritsira ntchito mapangidwe a nthawi yaitali kuti adziwitse kuchipatala kwa zizindikiro zokhudzana ndi chilakolako chokhudzidwa ndi chilakolako chokhudzidwa ndi chilakolako chokhudzidwa ndi kukakamizidwa.

Zopereka za Wolemba

NK ndi AV-G zathandiza kuti pakhale ndondomeko ya ndondomekoyi. NK analemba kalata yoyamba ya zolembedwazo. NK, EA ndi AV-G analemba zigawo za zolembedwazo. Olemba onse adapereka ndondomeko yosinthidwa, kuwerenga ndi kuvomereza mavoti omwe atumizidwa.

Kutsutsana kwa Chidwi

Olembawo akunena kuti kufufuza kunkachitika popanda mgwirizano uliwonse wa zamalonda kapena zachuma zomwe zingatengedwe kuti zingatheke kukangana.

Mawu a M'munsi

Ngongole. NK idathandizidwa ndi Faculty of Medicine, Nursing and Health Science Bridging Postdoctoral Fsoci kuchokera ku Monash University, Melbourne, VIC, Australia. EA idathandizidwa ndi thandizo la Chakudya, Kuzindikira komanso Khalidwe lochokera ku Netherlands Organisation for Scientific Research (Nederlandse Organisatie voor Wetenschappelijk Onderzoek, NWO, Grant 057-14-001). AV-G idathandizidwa ndi Next Generation Clinical Researchers Career Development Fellowship Level II kuchokera ku Australia Medical Research Future Fund (MRF1141214) ndipo idalandira thandizo la projekiti (GNT1140197) kuchokera ku National Health & Medical Research Council.

Zothandizira

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