Mathata a amanang le ho ja: Mokhoa o iphetotseng oa Psychoneuroimmunological (2019)

Mathata a ho ja ke mathata a tebileng a kelello a nang le biopsychosocial pathogenesis le litšenyehelo tsa theko e ka bang € 1 trillione ka selemo ho EU feela (Schmidt et al., 2016). Li ka fetoha li sa foleng le ho fokola 'me li amahanngoa le litekanyetso tsa batho ba shoang haholo.Schmidt et al., 2016). Mohlala, anorexia mothosa, e na le lenane le phahameng ka ho fetisisa la ho shoa ha batho bohle ba nang le mafu a kelello (mafu a 5.10 ho batho ba sekete ba anngoeng ke sena: Arcelus et al., 2011). Hoa tsebahala hore phekolo ea mathata a ho ja ha e na thuso ha e bapisoa le kalafo ea mafu a mang a kelello (Arcelus et al., 2011; Murray et al., 2019). Ho se sebetse hantle hona ho totobatsoa ke taba ea hore kalafo ea hajoale e shebane le ho fokotsa matšoao ho e-na le ho phekola sesosa sa mathata a ho ja. Lebaka le ka sehloohong la ho se sebetse hantle ha kalafo e seng e le teng ke hore, ha e le hantle, taba ea hore mathata a ho ja ha a utloisisehe hantle (van Furth le al., 2016; Frank le al., 2019; Murray et al., 2019). Tsoelo-pele tsebong ea mahlale ea mathata a ho ja e hlokahala ka potlako.

Tlhahlobo e felletseng ea tšobotsi kapa boits'oaro bo fanoa ka mokhoa o nepahetseng maemong a mabeli a fapaneng empa a tlatsana: (1) mochine oa proximate Tlas'a tšobotsi: e sebetsa joang? - le (2) ke eng lebaka la mantlha e bile teng: melemo efe, haeba e teng, e fa setho sa mmele? (Bateson le Laland, 2013; Rantala et al., 2018; Luoto et al., 2019a). Re kopanya maemo ana a mabeli a tlhahlobo mme re tiisa hore ntle le ho utloisisa mekhoa le sepheo sa mantlha, ho thata ho thibela mathata a ho ja le ho a fumanela kalafo e sebetsang.

Khatiso ea bohlano ea Diagnostic and Statistical Manual of Mental Dis shida (DSM-5) e bua ka mathata a mararo a ho ja: anorexia nervosa (AN), bulimia nervosa (BN) le bothata ba ho ja ka mokhoa o feteletseng (BED). Ntle le litsietsi tsena tse tharo, DSM-5 e hlokomela bohlokoa ba ts'ebetso ea maemo a tlase le maemo a atypical ka ho reha li-subtypes tse hlano tse boletsoeng tse ling tse boletsoeng e 'ngoe e boletsoeng:

1. Atypical Anorexia Nervosa (ke hore, likarolo tse nang le chefo ntle le boima bo tlase);

2. Bulimia Nervosa (ea maqhubu a tlase le / kapa nako e lekanyelitsoeng);

3. Binge Eating Disorder (ea khafetsa khafetsa le / kapa nako e lekanyelitsoeng);

4. Bothata ba ho Reka;

5. Syndrome ea ho ja bosiu.

DSM-5 e boetse e kenyelletsa sehlopha se bitsoang Unspecified Feeding kapa Eating Disorder (UFED) se kenyelletsang batho ba sa keneng ho e 'ngoe ea mekhahlelo ena e mehlano, kapa eo ho nang le tlhaiso-leseling e lekaneng ho etsa tlhahlobo e khethehileng ea OSFED (Mokhatlo oa Mahlale oa Amerika, 2013).

Ho khothalelitsoe maikutlo a 'maloa a thuto ea ho iphetola ha lintho bakeng sa ho hlalosa mathata a ho ja. Re shebisisa ka botebo li-hypotheses tsena tsa maemo a holimo (karolo e reng "Evolutionary Psychological Hypotheses for Eating Disorder") ebe re li kopanya ka tlhaloso e ncha ea tšebeliso ea mekhoa ea 'mele e bakang mathata a ho ja (karolo ea "Psychoneuroimmunological Model of Disney Disriers"). Mohlala oa rona oa psychoneuroimmunological o fana ka maikutlo a hore mathata a ho ja ha se mafu a arohaneng - ho fapana le hoo, a theha kemelo. Ho ipapisitsoe le phapang lithutong tsa bakuli ba bophelo bo botle ba mokuli, mohlala o tsoelang pele oa hlalosa hore na ke hobane'ng ha "mafu a sa hlalosoang a ho ja" e le ts'oaetso e tloaelehileng (11-50.8% ea linyeoe: Machado et al., 2013; Caudle et al., 2015; Mancuso et al., 2015) le hore na hobaneng ho hlahlojoa ke mokuli ho ka fetoha lipakeng tsa mathata a ho ja ka nako e telele (karolo ea "Mehloli ea Phapang e le 'ngoe Karabong ea Likarabo ho Phehisano ea Intrasexual"). Moetso o fana ka tlhaloso bakeng sa ho fumana hore mathata a ho ja hangata a tsamaisana le mathata a mang a kelello (karolo ea "Comorbidity of Eating Dis shida"): ho latela mohlala oa rona, phetisetso ena e arolelanoang e hokahanngoa le ho hlaseloa habonolo ke ts'usumetso ea khatello ea maikutlo le karabelo (karolo "Likotsi tsa Kotsi) Bakeng sa Mathata a ho ja ”). Mohlala oa rona oa psychoneuroimmunological o re lebisa ho ho fana ka maikutlo a kalafo (likarolo "Liphetoho tsa ho ja mathata a thehiloeng ho Psychoneuroimmunology" le "Ultimate-Level Prevention of Eating Disrupt") tse fanoeng ke kutloisiso ea maiketsetso ea methapo ea proximate le lisosa tsa mantlha. Litlhare tsena li na le monyetla oa ho fana ka tsoelo-pele e kholo litlamong tsa hajoale tsa ho ja, tse hlahlojoang hape karolong ea "Phekolo ea Khefutso ea Kelello ea Kelello".

Li-Hypotheses tsa Psychological tse teng bakeng sa Mathata a ho ja

Ho na le litekanyetso tse tšeletseng tsa thuto ea ho iphetola ha lintho tse bakang mathata a ho ja. Motsoako o ka pele oa thuto ea ho iphetola ha lintho oa BN le BED ke (1) the throtty genotype hypothesis. E fana ka maikutlo a hore ho itlopa lijo ke ho ikamahanya le maemo a kelello (bona mohlala, Lewis et al., 2017 bakeng sa puisano ea ho ikamahanya le maemo a kelello) e ileng ea hlaha hobane mabenkele a eketsehileng a matla a ne a sirelletsa nalaneng ea phetoho ea mefuta ea rona: ba ile ba thusa ho qoba khaello ea phepo e nepahetseng, ba thusa ho phela nakong ea tlala le ho beleha ka botlalo (Chakravarthy le Booth, 2004; Wells, 2006). Ka keketseho ea khopolo-taba ena, ntlha ea bobeli mohlala o tiisa hore 'mele o na le lintlha tse holimo le tse tlase bakeng sa boemo ba ho hlonepha ba mmele; haeba tsena li fetisitsoe, ts'ebetso ea likarabo tsa mmeleSpeman et al., 2011; Speakerman, 2018). Sebaka se tlase sa ho ikemela se hlokahalang ho qoba ho bolaoa ke tlala, athe sebaka se phahameng se behiloeng ke kotsi ea ho bolaoa esale pele. Ha kotsi ea ho lemosoa esale pele e fokotsehile, mefuta ea liphatsa tsa lefutso bakeng sa boemo bo phahameng bo phahameng e se e atile, mme ke batho ba fokolang ba fokotsang tšebeliso ea caloric ho thibela boima ba mmele (Speman et al., 2011).

(2) The intrasexual tlhodisano hypothesis (Abed, 1998) e fana ka maikutlo a hore sesosa sa mantlha sa mathata a ho ja ke tlholisano e matla e kenelletseng ho balekane. Khopolo-taba ena e hlokomela hore sebopeho sa 'mele oa mosali ke sesupo sa nalane ea hae ea ho ba le bana, ho ba le bokhoni ba ho ba le bana le boleng ba molekane, ka tsela e itseng e tšoaetsoa ke sekhahla le thekeng la boima ba' mele (BMI) (Andrews et al., 2017; Del Zotto le Pegna, 2017). Ha basali ba ntse ba tsofala le / kapa ba ikatisa, ba tloaetse ho ba le boima ba 'mele' me ba lahlehetsoe ke sebopeho sa mmele sa hora (Butovskaya et al., 2017) eo ke mokhoa o lakatsehang ho tsa thobalano ho banna (mohlala, Khotso, 2019). Lifensetere tsa ho ikatisa tsa basali li se li felile, ke ka hona banna ba hlahisitseng khetho ea litheko tsa bongoana le bocha (Sohn, 2016; Lassek le Gaulin, 2019). Sena se ka lebisa ho basali ba tlholisano le e mong bakeng sa tlhokomelo ea banna ka ho hlaha e le ba fokolang lilemong tsa bocha: boleng ba basali ba ho ikatisa, ka mora tsohle, bo amahanngoa le bocha, 'me bocha bo amahanngoa le ho fokola (Abed, 1998; Lassek le Gaulin, 2019).

Tekanyetso ea tlholisano ea makatsang e tsamaellana le lithuto tse bontšang hore khetho ea banna bakeng sa 'mele ea basali e ka fapana ho tloha tikolohong e' ngoe le sechabeng se seng ho isa ho se seng (cf. Furnham le Baguma, 1994; Tovee et al., 2006). Plumpness e ka ba sesupo sa tsoalo e phahameng linaheng tse nang le khaello ea phepo e nepahetseng; libakeng tse phetseng hantle, ka lehlakoreng le leng, plumpump e amanang le botsofali e amana le ho tsofala (mohlala, Tovee et al., 2006). Tlholisano e makatsang ea tlholisano e fana ka maikutlo a hore ho ata ha mathata a ho ja sechabeng sa batho ba bophirima ke lebaka la tlholisano e matla ea basali pakeng tsa basali le / kapa bongata ba lijo (Abed et al., 2012; Baumeister et al., 2017; Nettersheim et al., 2018).

Ho na le lintlha tse 'maloa tse eketsang tlholisano e kenelletseng (Abed et al., 2012): (a) ho theoha ha tsoalo ho lebisa ho pholoheng ho ponahalo ea nubile ho basali ba baholo; (b) lichabeng tsa sejoale-joale tsa Bophirimela, basali ba na le bokhoni bo phahameng ba ho laola boits'oaro ba bona (ka tšitiso e fokolang ho tsoa ho setho); (c) ho na le palo e phahameng e sa tloaelehang ea basali ba batjha le ba shebahalang ba le bacha, ke ho re, bao e ka bang bahlolisani, metseng ea kajeno ha ho bapisoa le maemo a batho ba baholo-holo; (d) mecha ea phatlalatso e fana ka litšoantšo tsa bahlolisani ba bohehang; (e) lijo li na le lijo tse ngata ebile bongata ba batho bo fepehile hantle, ka hona, phaello ea boima ba 'mele le ho fifala ha sebopeho sa nubile ke likarolo tse tloaelehileng tsa botsofaling; (f) ho hloka botsitso ha manyalo le ho ata ha tlhalo ho lebisitse ho banna le basali ho khutlela khafetsa marakeng; . Abed et al., 2012;; bona hape Baumeister et al., 2017; Saunders le Eaton, 2018; Lassek le Gaulin, 2019; Luoto, 2019a).

Phuputso e entsoeng linaheng tse 26 tse nkileng karolo ea batho ba fetang 7,000 e fumane hore sebopeho se tšesaane sa 'mele se khethoa libakeng tse nang le boemo bo phahameng sechabeng le hore litaba li na le kamano e kholo le boima ba' mele (Swami et al., 2010). Ho feta moo, Swami et al. (2010) o fumane hore basali ba ne ba lula ba nahana hore lipalo tse tšesaane tsa basali li ntle ho feta seo banna ba se nahanang. Baumeister et al. (2017) e tlaleha hore ha basali ba bangata ba hlokomela hore 'maraka oa moo oa mating o na le khaello ea banna, ke moo ba batlang ho fokola' me ba ba le matšoao a ho se khotsofale. Liphumano tsena li tšehetsa mohopolo oa hore tlholisano e kenelletseng har'a basali e khanna ho lelekisa basali hore ba be batenya.

Ts'ehetso e eketsehileng bakeng sa karolo e nahannoeng ea tlholisano e kenelletseng ea mathata a ho ja e tsoa ho "reore anorexia" e amang li-bodybuilders tsa banna (Mopapa le al., 1993hape e ka khanna ho se khotsofale ha 'mele ho bashanyana le banna (Karazsia et al., 2017). Batho ba amehileng ba bontša tumelo ea hore ba bonyenyane haholo leha ba le mesifa, ka hona ba ba le setšoantšo se khelohileng sa 'mele. Ho ba le mesifa le boholo ba 'mele bo fana ka melemo e hlakileng tlholisanong ea banna le banna ho liphoofolo tse ling; mesifa e kanna ea ba mokhoa o khahlehang ho tsa thobalano ho basali ba nalane ea rona ea ho iphetola ha lintho, ka khetho ea thobalano e sebetsang molemong oa banna esita le ba banna ba mehleng ena (Frederick le Haselton, 2007; Rekisa et al., 2017).

Ka lebaka la tlholisano e matlafalitsoeng le lintlha tse ling tsa ho iphetola ha lintho tse boletsoeng ka holimo, basali ba bangata lefats'eng la Bophirimela ha ba khotsofalle boholo ba 'mele le sebopeho sa bona,' me halofo ea banana ba lilemong tsa bocha e leka ho laola boima ba 'mele oa bona (Neumark-Sztainer, 2005). Boithuto ba liteko bo bontšitse hore leha ho se na mekhoa e khahlang ea bahlolisani, sepheo sa maemo a makatsang se khona ho baka maikutlo a ho ja a tšoanang le mathata a ho ja ho basali ba banyane (Li et al., 2010; Castellini et al., 2017). Phello e tšoanang ha e bonoe ho banna ba bong bo fapaneng (Li et al., 2010). Ntle le moo, mathata a ho ja a atile haholo har'a banna ba bong bo fapaneng ho feta ho banna ba bong bo fapaneng (Li et al., 2010; Calzo et al., 2018). Tlhaloso e ka bang teng bakeng sa liphumano tsena ke hore tlholisano e kenelletseng ho banna ba basodoma e tsepamisitse maikutlo ho boits'oaro bo botle ba 'mele, hobane banna ba bong bo tšoanang ba tseba hore matšoao a bocha le ho hohela' mele ke lintho tsa bohlokoa tseo ba ka khethang balekane ba tsona.Li et al., 2010). Banna ba basodoma ba boetse ba arabela tlholisanong ea maemo a makatsang ka maikutlo a fosahetseng a ho ja le maikutlo a mabe ka setšoantšo sa 'mele ea bona (Li et al., 2010).

Haeba tlholisano e kenang e le karolo ea bohlokoa kholisong ea mathata a ho ja, batho ba ikemiselitseng ho fihlela boemo ba bophelo bo amanang le ho tsofala ba ka ba kotsing e kholo ea ho ba le mathata a ho ja. Ho joalo, mathata a ho ja a qaloa hangata ho theosa le lilemo ha tlholisano e kenang e le matla (Li et al., 2010). Ntle le moo, ho bontšitsoe hore banana likolong tse nang le palo e phahameng ea baithuti ba basali ba na le monyetla o phahameng oa ho ba le mathata a ho ja (Bould et al., 2016), e fanang ka maikutlo a hore tikoloho e phahameng ea tlholisano e atisang ho eketseha ea mathata a ho ja (cf. Baumeister et al., 2017; Saunders le Eaton, 2018).

Mathata a amanang le ho ja hangata a tšoaetsanoa sechabeng ka lihlopha tsa metsoalle ebile a ka hasana tikolohong ea sekolo (Bould et al., 2016). Mohlala, haeba metsoalle ea motho e na le BMI e tlase ka lebaka la bothata ba ho ja, motho a ka bona hore mmele oa hae o moholo, o lebisa ho se khotsofatseng 'meleng le menyetla e phahameng ea ho ba le mathata a ho ja. Tlhahiso ena ea hore sechaba se na le mathata a ho ja e tšehelitsoe ke lintlha tse fumanoang hore likolong tse nang le palo e kholo ea banana ba tlase, banana ba bang ba na le monyetla oa ho leka ho theola 'mele.Mueller et al., 2010).

Ho boetse ho na le likhopolo-taba tse ling tse sa fumaneng tšehetso e fokolang ea maikutlo, joalo ka (3) the hypothesis ea ho ikatisa, e fanang ka maikutlo a hore AN ke teko e sebetsang ea ho ikatisa hoa basali ba amehang (Wasser le Barash, 1983; Phetoho, 1987; Voland le Voland, 1989). (4) Mokhatlo oa tšusumetso ea thetso ea botsoali e fana ka maikutlo a hore AN e lula e khethiloe ke khetho ea setho: batsoali ba qhekella bana ba basali ho tsamaisa phetoho e ntle ea matsete a ho ba le bana pakeng tsa banab'abo (Voland le Voland, 1989). (5) Mokhatlo oa khatello ea ho ikatisa ke litlatsetso tse tšehali tsa basali e fana ka maikutlo a hore AN ke ponahatso ea khatello ea botona ea botšehali ho basali ba maemong a tlase nakong ea tlholisano ea ho beleha basali le basali.Mealey, 2000). (6) Mokhatlo oa ikamahanya le maemo ho baleha komello ea tlala e fana ka maikutlo a hore matšoao a AN (joalo ka khatello ea lijo le thibelo ea lijo) a nolofalletsa ho falla nakong ea tlala ho ea libakeng tse nang le lijo tse ngata (Guisinger, 2003).

Mehopolo ena e shebane le AN, e siea mathata a mang a ho ja, haholo BED, ntle le tlhaloso. Hypotheses 3-5 e hloleha ho hlalosa hantle hore na hobaneng mathata a ho ja a hlaha le ho banna. Ba boetse ba hloleha ho hlalosa hore na ke hobaneng litakatso tsa thobalano li susumetsang monyetla oa ho ba le mathata a ho ja (Li et al., 2010; Calzo et al., 2018). Patlisiso e teng ha e fane ka maikutlo a hore batho ba nang le bothata ba ho ipolaisa tlala ba ka ba le maemo a tlase sechabeng a latelang “leano la ho lahleha” (Faer et al., 2005). Boholo ba likhopolo-taba tse thathamisitsoeng ka holimo li thehiloe khopolong ea hore mathata a ho ja ke liphetoho tsa tlhaho.

Ho fapana le litlatsetso tse ling, tlholisano e kenelletseng ea tlholisano ha e nahane hore mathata a ho ja ke maemo. Ntle le moo, ha e sebetse feela ho AN, empa e bona kakaretso eohle ea mathata a ho ja e le sephetho sa pherekano lipakeng tsa maemo a basali bakeng sa tlholisano e kenelletseng le tikoloho ea sejoale-joale moo maemo ao a fetoha. Leha ho na le matla a hlalosang a tlholisano ea tlholisano ea makatse, mosebetsi oa pele ho ts'ebeliso ea maikutlo o entsoe ka mokhoa o sa lekaneng ho fana ka tlaleho e felletseng ea tšimoloho ea mathata a ho ja. Ka hona, re e fetisetsa le mismatch hypothesis ea mathata a ho ja.

Mismatch Hypothesis ea Mathata a ho ja

Boholo bo boholo ke ntho e iphetotseng ea ho iphetola ha lintho. Phetoho ea moetlo oa batho e lebisitse boemong boo boholo ba bona bo ka mafura a mafura 'me gustatorly hyper-e-na le moputso Lijo li fumaneha habonolo bakeng sa batho ba bangata ba linaheng tse tsoetseng pele (Lindeberg, 2010; Matla, 2012; Rozin le Todd, 2015; Corbett et al., 2018). Ho ntša matla tikolohong ha ho hloke chelete e ngata bakeng sa batho ba sejoale-joale ba lulang lichabeng tse tsoetseng pele. Bongata bo matla ba hajoale boo batho ba sejoale-joale ba tsoetseng pele ba bo natefelang ke pale ea ho iphetola ha lintho: batho ba baholo-holo ba ile ba qobelloa (ka karolelano) ho sebelisa matla a mangata ho fumana mehloli ea lijo ho feta batho ba sejoale-joale. Lefu lena le bonolo le matla (lik'hilojule tse ka har'a likhalori) le lebisitse ho seoa sa botenya le mathata a bophelo ba sejoale-joale (Lindeberg, 2010; Matla, 2012; Corbett et al., 2018), ho kenyelletsa le bophelo bo botle ba kelello (Milaneschi et al., 2018; Rantala et al., 2018).

Batho ba na le mofuta oa mehleng ea khale oa boithuto ba tšebetso ba kelello (li-module) tse ikarabellang bakeng sa tšebeliso ea lijo (King, 2013; Al-Shawaf, 2016; Rolls, 2017; Lerato le Sulikowski, 2018) le mofuta o mong oa lienjene (li-module) tse ikarabellang bakeng sa ho tlolelana (Libeke-Shackelford le Shackelford, 2014; Luoto, 2019a, b). Tikoloho ea hajoale ea matla a mangata (Lindeberg, 2010; Matla, 2012) ba thehile khohlano ea nalane ea ho iphetola ha maikutlo lipakeng tsa li-module tsa kelello tse ikarabellang ts'ebetsong ea lijo le ho hola. Ka lehlakoreng le leng, batho ba bile teng hore ba sebelise monyetla oa ho ba teng ha phepelo ea lijo (Chakravarthy le Booth, 2004; King, 2013; Al-Shawaf, 2016); ka lehlakoreng le leng, batho ba bile teng hore ba supe bokhoni ba bona ba ho ba le bana ka mekhabiso ea thobalano ea phenotypic (Sugiyama, 2015; Lassek le Gaulin, 2019). Tlholeho ea setso e bile ka lekhetlo la pele nalaneng ea batho ea ho iphetola hoa lintho e hlahisitseng maemo ao ho 'ona liphetoho tsena tsa kelello li hanyetsanang haholo. Kahoo, mismatch hypothesis ea mathata a ho ja e hlokomela boemo ba haesale boo ho bona ho neng ho kopantsoe mekhoa e metle ea kelello ea ho ja lijo le ho tlolelana le maemo e le ho hanyetsa. Bofetoheli bona bo baka boemo boo ho bona motho a arotsoeng lipakeng tsa likhothaletso tse hanyetsanang: meputso ea lijo le meputso ea ho hola. Ho hlahisa ka nako e le 'ngoe ha ho na le mathata a fapaneng a feto-fetohang metaproblem e sebetsang (Al-Shawaf, 2016). Taba ea mantlha e khahlanong le hore na bongata ba lijo tse matlafatsang tse nang le khalori e matlafatsang.Lindeberg, 2010; Rozin le Todd, 2015) e bakile lipakeng tsa sepheo sa ho holofatsa le meputso ea lijo e khannela mofuta o joalo oa metaproblem ho batho ba mehleng ena, e hlahang qetellong litsietsing tse fapaneng tsa ho ja.

Mismatch hypothesis e ka qhekelloa ka ho bontša hore mathata a ho ja a atile ka mokhoa o tšoanang mekhatlong ea setso ea litsomi joalo ka ha e le mekhatlong ea sejoale-joale e tsoetseng pele. Mekhoa ea ho iphelisa ea litsotsi e batla e bapisoa le maemo a tikoloho ea batho ea ho iphetola ha lintho (mohlala, Al-Shawaf, 2016; Lewis et al., 2017). Ha re tsebe bopaki leha e le bofe mabapi le boteng ba AN, BN le BED mekhatlong ea batho ba tsomang - ka lehlakoreng le leng, tlala e bonahala e le karolo e atileng ea mekhatlo ea sejoale-joale ea litsomi (e lekantsoeng ho Al-Shawaf, 2016).

Mismatch hypothesis e tšehetsoa ka mokhoa o sa tobang ke lipatlisiso tsa liphoofolo tseo eseng tsa batho tse bonts'itseng hore botenya bo fetoha bothata ba bohlokoa ha feela batho ba boloka liphoofolo kholehong.Matla, 2012). Bokgoni bo bontša boemo bo atileng ba ho fetoha ha liphoofolo bakeng sa liphoofolo tseo e seng batho joalo ka ha mekhoa ea bophelo ea morao-rao e etselitsoeng batho (Williams, 2019), e lebisang ho eketseheng ho atileng ha litekanyetso tsa botenya tlasa maemo ana ka bobeli (Matla, 2012). Liphumano tsena li bonts'a ts'ebeliso ea mathata a ho ja a ipatileng moelelong oa tšibollo ea mismatch e sa sebetseng, eo re e khothalletsang e le keketso e hlokahalang ho tlholisano ea tlholisano ea makatsang. Ntle le mathata a ho ja, hypothesis ea mismatch e boetse e hlalosa mafu a seoa a mafu a 'maloa a sa tšoaetsanoeng, a kang lefu la tsoekere la mofuta oa 2, lefu la mokokotlo oa mokokotlo (Corbett et al., 2018) le mathata a mang a mangata a bophelo bo botle ba kelello (Li et al., 2018; Rantala et al., 2018).

Mohlala oa Psychoneuroimmunological oa Mathata a ho Ja

Tlholisano e kenelletseng lipakeng tsa botenya le metaproblem e lumellanang e hlahisoang ke bongata ba lijo tse matlafatsang tse nang le phepo e ntle (King, 2013; Rozin le Todd, 2015) bonahala eka e fana ka tlhaloso e hlakileng ea ho phehella ho nyopa ho basali ba lulang libakeng tse tsoetseng pele. Le ha ho le joalo, maikutlo ana ha a hlalose hore na ke hobaneng feela karolo ea basali le banna ba basodoma e e-ba le mathata a ho ja. Ntle le moo, litšoaneleho ha li hlalose hore na ke hobaneng ha batho ba bang ba e-ba le mokhoa o matla oa ho tsilatsila ho fokotsa boima ba 'mele hoo ba ipolaeang ke tlala, ha ba bang ba itlopa lijo le ho nona. Hypotheses e boetse e sitoa ho hlalosa boteng ba AN e seng mafura (sheba karolo ea "Autoimmunity and Eating Disriers").

Tsoelo-pele ea mahlale e itšetlehile ka ho lumellana hantle pakeng tsa thuto le bopaki bo matla (Mathot le Frankenhuis, 2018). Ho lekana hona joale ho haella pakeng tsa mohopolo oa thuto ea kelello ea thuto ea ho iphetola ha lintho le bopaki ba tleliniki mabapi le mathata a ho ja. Ka hona re fana ka maikutlo a ho ba teng ha metheo ea ho hlaka e hlalosang phapang pakeng tsa motho ka mong le motho kahare bothateng ba ho ja, le ho ntlafatsa ho lekana lipakeng tsa liphetho tsa maikutlo le tse matla. Re fana ka tlhahiso ea sebopeho se secha se hlalosang liphetho tsa hore (1) tlholisano e matla ea tlhalohanyo e lebisa ho mathata a ho ja ka karolo e nyane feela ea basali; (2) ts'ebetso ena ea basali e ka ba le mathata a ho ja a kenyelletsang liphetho tse fapaneng le botenya bo feteletseng le botenya; le (3) ho hlahlojoa ke mokuli ho ka fetoha lipakeng tsa mathata a ho ja ka nako e telele.

Mathata a ho ja le ho hloka taolo ho feta tekano

Ho latela maemo a ho khetholla, ho ikoetlisa ka ho ikoetlisa ka 'mele, ponahalo le lijo li tloaelehile mathateng a ho ja (Mokhatlo oa Mahlale oa Amerika, 2013). Lintho tsena li lebisa ho nyahameng maikutlong le kholisong ea boits'oaro bo kang ho hlahloba boima ba 'mele, ho ikoetlisa, ho itlhoekisa kapa ho itima lijo. Ntle le matšoao ana a mantlha a mathata a ho ja, litšobotsi tse ling tse ngata tse bonts'ang kelello, tse kang ho belaela, ho hlahloba le tlhokahalo ea tatellano ea liketsahalo le ho nepahala li atile haholo ho bakuli ba BN le AN ho feta lihlopheng tsa taolo ea kelello.Cassidy et al., 1999). Bakuli ba bang ba nang le bothata ba ho ja ba na le tloaelo ea ho shebella kapa e bopehileng joaloka ho ama likarolo tsa 'mele khafetsa kapa ho sheba sebopeho sa' mele oa bona ka seiponeng.Legenbauer et al., 2014). Kahoo, boitšoaro ba bakuli ba nang le bothata ba ho ja bo na le lintho tse ngata tse tšoanang ka boitšoaro ba OCD (Bastiani et al., 1996; Garcia-Soriano et al., 2014). Phuputsong e 'ngoe ea lelapa la Sweden le mafahla a Sweden tse kenyelletseng barupeluoa ba 19,814 ba nang le tlhahlobo ea OCD le ba 8,462 6.4 ba nang le banna ba 16%, ho fumanoe hore basali ba nang le OCD ba na le tlhahlobo ea makhetlo a 37 ea AN, athe banna ba nang le OCD ba ne ba na le XNUMX Kotsi e eketsehile (Cederlof et al., 2015). AN le BN li boetse li amahanngoa le litšobotsi tsa botho tse hokahaneng le OCD, joalo ka phetheho le neuroticism (Cassidy et al., 1999; Anderluh et al., 2003; Halmi et al., 2005; Altman le Shankman, 2009). Ntle le moo, AN e atile haholo bathong ba sa amehang ba nang le OCD, ha a bapisoa le ba leloko la taolo e tšoanang, a fana ka maikutlo a mabaka a arolelanoang a lefutso.Kaye et al., 1993). Ka lebaka leo, tlhahlobo ea meta ea GWAS e fumane kamano pakeng tsa liphatsa tsa lefutso pakeng tsa AN le OCD phenotypes (Antila et al., 2018).

Phuputso ea morao-rao ea positron emission tomography (PET) e fumaneng neuroinfigueation ho bakuli ba OCD; ka ho khetheha, ba phahamisitse tšebetso ea microglia bokong ba bona (Bahlahisi et al., 2017). Matšoenyeho a amanang le ho thibela boits'oaro bo qobellang a tsamaisana ka matla le neuroinfigueation ho orbitofrontal cortex (Bahlahisi et al., 2017). Ho ka etsahala hore neuroinfigueation e baka moferefere oa liketsahalo tsa biochemical tse qetellang kaholimo oa methapo ea methapo ea kutlo, li-neuropeptides le li-neurotransmitters tse bakang matšoao a OCD. Leha ho le joalo, lipatlisiso tsa pele (Bahlahisi et al., 2017) ha e khone ho hlalosa hore na hobaneng bakuli ba OCD ba na le neuroinflammation.

Leha maikemisetso a ho OCD a baka khatello e kholo ho bakuli, khatello ea maikutlo ka boeona e bonahala e bapala karolo ea bohlokoa ho qaleng ha OCD (Toro et al., 1992; Behl et al., 2010; Adams et al., 2018). Ho imeloa kelellong ho baka matšoao a OCD hape ho eketsa khafetsa le ho teba ha tsona (Fumanaley et al., 2003). Boithuto ba boithuto ba liphoofolo tseo e seng batho bo bonts'itse hore khatello ea maikutlo e eketsa neuroinfigueation mme e phahamisa tšebetso ea microglia (e hlahlojoe ho Calcia et al., 2016). Kahoo, khatello ea maikutlo e sa foleng e kanna ea baka mofere-fere o hlahang mofuteng oa OCD oa phenotype. Kaha khatello ea maikutlo le ts'ebetso ea li-axis tsa HPA li na le karolo ea bohlokoa ho OCD (Sousa-Lima et al., 2019), motho a ka lebella kamano e ts'oanang le khatello ea maikutlo le matšoao a ho kula.

Mathata a ho ja le khatello ea maikutlo

Batho ba nang le BN le AN ba leka ho theola boima ba 'mele ho fihlela “botle bo botle” le ho phehella tlholisano e kenelletseng ea ho fokola (cf. Abed, 1998). Bakuli ba AN le BN ba arabela tlholisanong ka litekanyetso tse phahameng tsa li-hormone tse ba tse sa foleng ha nako e ntse e ea (bona Soukup et al., 1990; Rojo et al., 2006). Matšoenyeho a ka bakoa ke khatello ea lithaka le ea sechaba ho ba le "mofuta o phethahetseng oa 'mele" (Castellini et al., 2017), leha maikutlo a lihlong le ho ikutloa a le molato ka setšoantšo sa hae se ka etsa hore batho ba tsoelepele mokhatlong o mobe oa khatello ea maikutlo. Bakuli ba bang ba nang le AN ba hlokometse hore kannete maikutlo a fosahetseng ka boima ba 'mele ea bona e bile ketsahalo e makatsang bakeng sa AN (Dignon et al., 2006). Haholo-holo lipapaling moo boima ba 'mele bo leng tlholisano, litlhoko tsa ho fokola li ka baka bothata ba ho ja (Joy et al., 2016; Arthur-Cameselle et al., 2017). Hoa tšoana le lefatšeng la feshene, motjeko le ballet (Marquez, 2008). Tlhokahalo ea ho theola boima ba 'mele papaling le fesheneng e ka baka ho se khotsofale ha' mele le khatello ea maikutlo sechabeng (cf. Castellini et al., 2017).

Patlisiso e khutlang ho bakuli ba nang le AN le BN e thathamisitse liketsahalo tse ling tse tšeletseng tse bakang mathata a ho ja: (1) liphetoho tsa sekolo, (2) lefu la setho sa lelapa, (3) likamano li fetoha, (4) phetoho ea lapeng le ea mosebetsi, (5) bokuli / ho kena sepetlele le (6) tlhekefetso, tlhekefetso ea thobalano kapa setho sa thobalano (Berge et al., 2012). Tse tloaelehileng liketsahalong tsena tsohle tse susumetsang maikutlo ke hore li tsejoa ho eketsa khatello ea maikutlo. DSM-5 ka hona e re ho qaleha khafetsa ho amana le liketsahalo tse sithabetsang tsa bophelo (Mokhatlo oa Mahlale oa Amerika, 2013).

Khatello ea kelello e sa feleng e tsejoa ho nyolla sesole sa 'mele (se hlahlojoang ka Stanton et al., 2018; Mosebetsi, 2019). Boithuto ho batho le liphoofolo tse ling bo bontšitse hore khatello ea maikutlo sechabeng ke eona e bakang tšusumetso ea tlhahiso ea li-cytokine tsa proinfigueatory tse ka khothaletsang tšoaetso ea methapo e tlase le ho hlakahlahala. Ho lahloa ha sechaba ho batho ho amana le maemo a eketsehang a tumor necrosis factor-α (TNF-α) le interleukin-6 (IL-6) (Slavich et al., 2010). Ka lebaka leo, tlhahlobo ea meta e kenyelletsang liphuputso tse 23 e fumane hore bakuli ba AN ba ekelitse maemo a TNF-α le IL-6 haholo, ba fana ka maikutlo a hore bakuli ba AN ba na le sesole sa 'mele se fokotsang matla (Dalton et al., 2018). Leha ho le joalo, lithuto ha lia khona ho khetholla monyetla oa hore ho eketseha ha IL-6 ho etsahala ka lebaka la boima ba 'mele. Kaha IL-6 e matlafatsa lipolysis (Wedell-Neergaard et al., 2019), ha ho hlake hore na maemo a eketsehang a IL-6 a bakoa ke khaello ea phepo e nepahetseng kapa ho ruruha kapa ka bobeli. Leha ho le joalo, Dalton le al. (2018) o fumane hore bakuli ba nang le AN le bona ba na le maemo a phahameng a IL-15. IL-15 e amana le neuroinfigueation (Pan et al., 2013), ho fana ka maikutlo a khokahano lipakeng tsa AN le neuroinflammation.

Joalo ka bakuli ba AN (Solmi et al., 2015; Dalton et al., 2018), batho ba nang le OCD le bona ba na le maemo a eketsehileng a TNF-α le IL-6 (Konuk et al., 2007). Kaha bakuli ba AN le BN hangata ba fumanoa ba na le OCD (mme kaha ho theola boima ba 'mele e ba ntho e matla ho bona), re kholoa hore neuroinfranceation e bakoa ke khatello ea maikutlo e bakoang ke AN le BN - joalo ka OCD (cf. Bahlahisi et al., 2017). Bopaki bo sa reroang bakeng sa phepelo ena bo tsoa liphatlalatsong tsa hore 74% ea bakuli ba nang le AN le BN ba tšoeroe ke migraine (Brewerton le George, ka 1993; Brewerton et al., 1993; D'Andrea et al., 2009), e leng lefu la neuroinflammatory (Malhotra, 2016). Ho tloha ka tlala ho tsejoa ho eketsa maemo a lihormone (Naisbitt le Davies, 2017), ho bonahala eka ho ipolaisa tlala ho ka 'na ha matlafatsa ho tetebela ho tlatselletsang kelello ho theola boima ba bakuli ba AN. Loop ena ea ho fana ka maikutlo e ka etsa hore ho be le potoloho e mpe eo ho ka bang thata ho e emisa le e ka nyolohelang maemong a sokelang bophelo. Ho khahlisang ke hore na khatello ea kelello ea "cortisol" ea khatello ea maikutlo e ts'oeroeng ho bakuli ba AN (bona Soukup et al., 1990; Rojo et al., 2006) ke e 'ngoe ea lihormone tse eketsang gluconeogenesis ho batho. Gluconeogenesis ke ts'ebetso ea ho kopanya glucose 'meleng ho tsoa liprotheine kapa mafura, ho sebelisoa e le matla ke' mele (Khani le Tayek, 2001). Ka ho eketseha ha lihormone tsa khatello ea kelello, gluconeogenesis e ka eketsa neuroinfigueation nakong ea ho ja le ho bolaoa ke tlala ho bakuli ba AN.

Liphuputso tse entsoeng ho batho le ho liphoofolo tse ling li bontšitse hore li-cytokin tse fokotsang matla a ho kula li fokotsa takatso ea lijo 'me li ka baka ho ipolaisa tlala (Dantzer, 2009). Mokhoa oa moputso oa mesolimbic, o sebelisang takatso ea takatso ea lijo le boleng ba hedonic, ha o sebetse hantle ho bakuli ba AN joalo ka taolo e phetseng hantle kapa ba nang le mathata a ho ja (Ceccarini et al., 2016). Kahoo, ho ja ho kanna ha se bake ketsahalo e tšoanang le ea bokuli bakeng sa bakuli ba AN joalo ka ha e etsa ho batho ba sa amehang (cf. Stanton et al., 2018). Ho theoha hona hoa hempiki ho ka kenya letsoho ka tsela e itseng mosebetsing oa bakuli ba ho ja, ha ba jang ba bangata ba phetseng hantle ba hloleha boitekong ba bona (bona Mann et al., 2007).

Ho itlopa lijo le khatello ea maikutlo

Joalo ka BN le AN, re nahana hore maemong a mangata, BED e boetse e bakoa ke tlholisano e kenelletseng ea botona. Bopaki bo sa tobang bakeng sa tšusumetso ena bo fanoa ke liphetho tse bonts'a hore bakuli ba BED ba na le boitšepo bo tlase, ho se khotsofale ha mmele ka kakaretsoPearl et al., 2014) le khatello e phahameng ea kelello (Castellini et al., 2017; Mustelin et al., 2017). Ba tloaetse ho feta boima ba bona le ho bona 'mele ea bona e le bobebe (Pearl et al., 2014). Leha a na le sepheo sa ho fokotsa boima ba 'mele, bakuli ba BED ba qetella ba ja ho feta tekano le ho ba le boima bo bongata ba mmele, hangata bo lebisa ho botenya. Castellini et al. (2017) ea tlaleha hore ho itlopa lijo ho ne ho amahanngoa le tlhompho ea setšoantšo sa 'mele le khatello e kholo ea thobalano ho basali bao e seng baoki, ho ts'ehetsa maikutlo a rona a hore BED e bakoa ke tlholisano e kenelletseng ea botona. Khopolo-taba ena e ka phephetsoa ke ho bonts'a matšoao a BED ke phello ea BED ho fapana le sesosa sa eona. Leha ho le joalo, tlhahlobo e ileng ea bapisa batho ba tloaelehileng ba boima ba BED le batho ba batenya haholo ba BED e fumane hore tse boima ka tloaelo li na le takatso e matla ea ho theola boima ho feta ba batenya haholo (Goldschmidt et al., 2011). Ho ne ho se na liphapang pakeng tsa sehlopha ka bongata ka ho fetesisa sebopeho kapa boima, ho fana ka maikutlo a hore matšoao ana ha a hlahisoe ke botena ba comorbid (Goldschmidt et al., 2011).

Le ha batho ba bangata ba felloa ke takatso ea lijo ha ba ikutloa ba imetsoe haholo kelellong, esita le khatello ea maikutlo e bobebe kapa ketsahalo e mpe e ka baka ho jella ho ja ho bakuli ba BED kapa BN (Masheb et al., 2011). Ka tloaelo khatello ea maikutlo e baka ts'ebetso ea kutloelo-bohloko ea kutloelo-bohloko le karabelo ea 'mele ea ho loana kapa ho fofa. Tlas'a maemo ana, corticotropin-releasing factor (CRF) e hatella takatso ea lijo ka ho ama sistimi ea lijo le ho fokotsa maikutlo a tlala. Ke ka lebaka leo batho ba nang le BED ba sa utloeng litakatso tse ngata tsa ho itlopa lijo le ho itlopa lijo ka nako ea khatello ea maikutlo, empa boinotšing ba malapa a bona le ha ba le bang nako e telele kamora hore khatello ea maikutlo e theohile (Masheb et al., 2011). Ho itlopa lijo ho ka bonoa e le tsela ea ho “baleha” ho tsoa ho maikutlo a khathollang maikutlo (Burton le Abbott, 2019).

Bakuli ba BED le BN ba na le takatso ea ho theola boima ba 'mele, ka hona ho bohlokoa ho utloisisa hore na hobaneng ho le thata haholo hore ba hane ho ja ho feta tekano. Lebaka le ka ba teng mokhoeng oa bona oa ho ja. Likhotong tse thibelang khalori feela, khatello ea kelello e bontšitsoe ho baka linako tse jang tsa ho ja haeba lithuto li na le monyetla oa ho ja lijo tse nang le tsoekere le mafura a mangata.Hagan et al., 2002, 2003). Ka mokhoa o ts'oanang, khatello ea kelello e fokotsoang ke thibelo ea khalori e lebisa likhoto ho ja habeli tekanyo e tloaelehileng ea lijo (Boggiano et al., 2005). Likhoto tse thibelang lijo tse hatisoang ka mokhoa o itekanetseng li baka ho ruruha libakeng tse sa bonahaleng tsa boko tse laolehang ka kotloloho kapa ka tsela e sa laoleheng; likhoto tsena li boetse li ba le mekhoa e tloaelo ea ho ja.Alboni et al., 2017). Ka mokhoa o ts'oanang lithutong tsa batho, khatello ea kelello e ka baka ho jella lijong tsa phepo e ntle haeba lijo tse fumanehang habonolo li fumaneha.Oliver le Wardle, ka 1999;; bona hape Castellini et al., 2017; Klatzkin et al., 2018).

Tlhahlobo ea boemo ba psychophysiological ba bakuli e fana ka leseli le eketsehileng ho BED. Bakuli ba BED ba na le karabelo e phahameng ea khatello ea maikutlo ho feta taolo (Klatzkin et al., 2018). Bakuli ba BED ba ka fetohela ho itlopa joala habonolo ho feta ho laoloa hantle ka lebaka la karabelo ea bona e phahameng ea khatello ea kelello (cf. Klatzkin et al., 2018). Lebaka le leng la karabelo ea bona e phahameng ea khatello ea maikutlo e ka ba ho ruruha ho bakoang ke lisele tsa mafura a visceral (Shields et al., 2017; Krams et al., 2018; Mosebetsi, 2019). Leha khatello ea kelello le kelello li le teng bophelong ba batho ba bangata, bokhoni ba ho itaola bo sitisa batho ho hanyetsa litlamorao tse mpe tse bakoang ke khatello ea maikutlo khafetsa (Evans le Fuller-Rowell, 2013; Shields et al., 2017). Bopaki bo felletseng bo fana ka maikutlo a hore ho ruruha ho ka baka phetoho e pharalletseng ea bophelo bo botle e khothalletsang ho hloleha ho itaola (Shields et al., 2017). Bakuli ba BED ba na le 88% ea boleng bo phahameng ea CRP ho feta taolo e lekantsoeng bakeng sa boima ba 'mele, ho fana ka maikutlo a hore bakuli ba BED ba na le tšoaetso e matla' meleng oa bona (Safe, et al., 2015). Ho ruruha ho ka fokotsehang ka hona ho ka fokotsa bokhoni ba ho itaola (Shields et al., 2017) ho bakuli ba BED le ho eketsa karabelo ea bona ea khatello ea maikutlo. Lebaka ke hobane li-cytokine tsa proinflammatory tse hlahisoang ke lisele tsa 'mele tse sirelletsang kapa li-adipocytes li tsejoa ho susumetsa axis ea HPA (Yau le Potenza, 2013). Khokahano ena ea mochine e ka baka potoloho e mpe, e lebisang ho nona (cf. Shields et al., 2017; Milaneschi et al., 2018) mme, joalo ka ha re fana ka maikutlo, ho BED. Ho ruruha ho sa feleng ke mokhoa o ka bakang ho hlasela o hlalosang hore na hobaneng mathata a ho feto-fetoha ha maikutlo a atile hakana ho bakuli ba BED: mohlala, ho ruruha ho eketsa monyetla oa hore phetoho ea maikutlo e feto-fetohang e fetohe ho tepelletseng ho hoholo ha bongaka (cf. Luoto et al., 2018; Rantala et al., 2018). Mabaka a liphatsa tsa lefutso a ka boela a eketsa pherekano lipakeng tsa mafu ana (joalo ka ha ho hlahlojoa khaolo ea "Likotsi Tsa Kotsi Bakeng sa Ho Kula ').

Neurochemistry ea Anorexia Nervosa le Bulimia Nervosa

Serotonin (5-hydroxytryptophan) e tsejoa ho susumetsa taolo ea tšusumetso, ho tsieleha, maikutlo le takatso ea lijo (Bailer le Kaye, 2011; Dalley le Roiser, 2012; Garcia-Garcia et al., 2017). Mekhoa ea kalafo e ntlafatsang ts'ebetso ea serotonergic e fokotsa tšebeliso ea lijo, ha mekhoa ea kalafo e nyenyefatsang ts'ebetso ea serotonergic e eketsa ts'ebeliso ea lijo le ho phahamisa phaello ea boima ba 'mele (e hlahlojoe ho Bailer le Kaye, 2011;; bona hape Alonso-Pedrero et al., 2019). Boithuto ho bakuli ba AN bo tlalehile serysonergic system dysfunction (e lekantsoe ho Bailer le Kaye, 2011; Riva, 2016). Ho khahlisang, IL-15 e ngolisitsoe ho bakuli ba AN (Dalton et al., 2018), le lithuto tse mabapi le litoeba li bontšitse hore IL-15 e nyolla tsamaiso ea serotonergic (Wu et al., 2011; Pan et al., 2013).

Karolong e mpe ea AN (ha batho ka bomong ba le boima bo tlase), bakuli ba na le li-metabolites tse tlase haholo tsa serotonin ka mokelikeli oa bona oa "cerebrospinal" ho feta taolo e phetseng hantle (Kaye et al., 1984, 1988). Ba boetse ba sentse karabelo ea prolactin ho lithethefatsi tse nang le ts'ebetso ea serotonin mme li fokotsehile ³H-imipramine e tlamang, e fana ka tlhahiso ea ts'ebetso ea serotonergic e fokotsehileng (Bailer le Kaye, 2011). Kaha serotonin e hlophisitsoe ho tsoa ho amino acid e bitsoang tryptophan, amino acid ea bohlokoa e lokelang ho fumanoa lijong, tlhaloso e hlakileng ka ho fetisisa ea metabolism e tlase ea serotonin ho bakuli ba AN nakong ea karolo e mpe ea bokuli ke hore e hlaha ka lebaka la tlala / ho ja.Kaye et al., 2009; Haleem, 2012). Ka lehlakoreng le leng, batho ba hlaphohileng ho AN ba phahamisitse maemo a serotonin (Kaye et al., 1991). Phuputso e entsoeng mabapi le liteko e fumane hore phokotso ea "tryptophan" ea lijo e fokotse khatello ea maikutlo le boemo bo phahameng ba basali ba nang le AN, empa ha e na phello ho taolo ea basali (Kaye et al., 2003).

Bakuli ba tsebahala hore ba na le matšoenyeho a mangata, ho se tsotelle le ho qoba likotsi pele ho nako le kamora ho hlaphoheloa. Li kanna tsa ba le maemo a holimo a serotonin premorbidly, ea fella ka naha ea dysphoric (Bailer le Kaye, 2011). Kaye et al. (2009) o khothalelitse hore ho ja / ho bolaoa ke tlala ho etsa hore bakuli ba AN ba ikutloe ba le betere ka ho fokotsa tšebetso ea serotonergic bokong. Batho bana ba ka fumana likarabo tse ntle ho tsoa ho lithaka tsa bona ka ponahalo ea bona e bobebe, e ba susumetsang le ho feta hore ba tsoele pele ho bolaoa ke tlala. Ka lebaka la ho theoha ha tryptophan ho bakoang ke tlala, kelello e arabela ka ho eketsa palo ea li-receptor tsa serotonin ho sebelisa serotonin e setseng hantle ka mokhoa o atlehileng haholoanyane (Kaye et al., 2009). Sena se lebisa ho potoloha e mpe ea homeostatic (Setšoantšo sa 1), hobane ho ikutloa hore o ikutloa a le betere, bakuli ba AN ba hloka ho fokotsa tryptophan le ho feta, e lebisang ho phokotso ea tšebeliso ea lijo (Kaye et al., 2009). Haeba mokuli a qala ho ja lijo tse nang le tryptophan ho eona, maemo a serotonin a hlaha ka sekhahla a bakang matšoenyeho a feteletseng le pherekano ea maikutlo (Kaye et al., 2009). Sena se etsa hore ho be thata ho hlaphoheloa ha bakuli ba AN (Kaye et al., 2009). Ho theoha ha litekanyetso tsa serotonin nakong ea mokokotlo oa bokuli ka lebaka la khaello ea tryptophan (Riva, 2016) e ka hlalosa litšitiso tse tebileng tsa setšoantšo sa 'mele tse tloaelehileng ho AN. Le ha ho tsebahale hore na mochine o amanang le methapo ea kutlo o bakang pherekano e joalo, mochine ona o kanna oa itšepa haholo ha o bonoa khafetsa (cf.) Orth le Robins, 2013).

Kaye et al. (2009) hypothesised hore batho ba nang le AN ba na le sekoli se kenang tsamaisong ea bona ea serotonergic le hore liphetoho tsa gonadal steroid nakong ea ho qala ha matsatsi kapa litaba tse amanang le khatello ea maikutlo mabapi le ho ba moroetsana tsa bocha li ka eketsa tšebetso ea sistimi ea serotonergic. Leha ho le joalo, tlhaloso ena ha e khone ho ikarabella bakeng sa ho ata ha BATHO litabeng tsa sejoale-joale kapa ka lebaka la bothata ba ho ja ho banna. Ho hokahanya lits'ebetso tsa proximate le lisosa tsa mantlha, ho bohlokoa ho ela hloko nako ea ho qala ha AN ho ea matsatsing le ho ba motho e moholo ha a sa le joalo ka lebaka la tšebeliso e matla ea tlholisano e matla ea ho ba mosesanyane ho potoloha nako ena e bohareng holima kholo ea kholo. Tlholisano e kenelletseng hare e ka baka khatello e matla ho batho ba nang le tlholisano haholo (cf. Vaillancourt, 2013). Bohlokoa, khatello ea maikutlo e sa foleng e tsejoa ho eketsa maemo a serotonin bokong ka bobeli ho batho (ho hlahlojoa ka Hale et al., 2012) le liphoofolong tse ling (mohlala, Adell et al., 1988; Keeney et al., 2006; Vindas et al., 2016). Boithuto ba liteko tsa likhoto li bonts'itse hore ho itima lijo ho fokotsa maemo a serotonin bokong (Haleem le Haider, 1996). Mokhoa o tšoanang o ka etsahala le ho batho ba sithabetseng ba nang le kemiso e ntlafalitsoeng ea serotonergic ha ba qala ho ja ho fokotsa mmuso oa dysphoric. Kakaretso, liphuputso tsena li hlalosa karolo e 'ngoe ea khokahano e teng pakeng tsa khatello ea maikutlo le ho ja ka tsela e sa fetoheng (Setšoantšo sa 1).

Ho boetse ho na le bopaki ba ho se sebetse hantle tsamaisong ea serotonergic ho bulimia mothosa (e lekantsoeng ka Sjögren, 2017), empa ka tsela e fapaneng ho feta ho AN. Tekanyetso ea bakuli ba BN e theoha haholo ho feta taolong e phetseng hantle esita le nakong ea ho itima lijo nakoana tse ling (mohlala, nakong ea boroko), e lebisang ho hoeng hoa utloahala le likotsi tsa ho ja ka mokhoa o feteletseng (Steiger et al., 2001). Ts'ebetso tsena tse mpe ts'ebetsong ea sisteme ea serotonergic li phehella kamora ho hlaphoheloa, li fana ka maikutlo a hore li kanna tsa ba li bile teng pele ho qaleho ea BN (Kaye et al., 2001). Ho fapana le bakuli ba AN, ho theoha ha tryptophan ho bakuli ba BN ho kokobetsa maikutlo mme ho baka takatso ea ho ja haholo (e hlahlobile ka Sjögren, 2017). Phuputso e entsoeng ka neuroimaging e fumane ho tlama ha 5-HT1A ho bakuli ba BN ha ho bapisoa le taolo e phetseng hantle (Galusca et al., 2014). Ho kenngwa tshebetsong ha serotonin receptor 5-HT_2CFokotsa ho ja lijo tse matlafatsang ka mokhoa oa rat (Martin et al., 1998; Fletcher et al., 2010; Higgins et al., 2013; Theko et al., 2018). Ka mokhoa o ts'oanang, litlhare tsa SSRI li fokotse takatso ea ho itlopa lijo (e hlahlojoang hape ka Tortorella et al., 2014). Liphumano tsena li tšehetsa khopolo ea hore bakuli ba BN ba fokolitse tlhahiso ea serotonin tsamaisong ea methapo e meholo.

Mehloli ea Phapang ea Motho ka Mong Karabelo ho Phehisano ea Intrasexual

Ho na le phapang e kholo ea motho ka mong karabelong ea tlholisano ea basali le basali: batho ba bang ba itlopa lijo ha ba bang bona ba bolaoa ke tlala (Setšoantšo sa 2). Boholo ba basali ba bacha ba pepesetsoa tlholisano e ikhethang ea botenya, empa ke karolo e fokolang feela ea bona e nang le bothata ba ho ja. Lebaka la phapang ena ho bonahala le amana le phapang e le 'ngoe ea karabelo ea khatello ea maikutlo le ts'ebetsong ea sistimi ea serotonergic. Ho utloisisa etiology ea mathata a ho ja, potso e 'ngoe ea mantlha ke: mehloli ea mantlha ea karabelo ea khatello ea maikutlo le ts'ebetso ea ts'ebetso ea serotonergic ho batho ba nang le bothata ba ho ja ke efe?

Ntho e ka etsang hore ho be le phapang lipakeng tsa likoluoa ​​tsena e ka ba dysbiosis (cf. Temko et al., 2017). Palo e kholo ea bopaki bo matla ho liphoofolo tse ling e fana ka maikutlo a hore li-gut microbiota li susumetsa karabelo ea khatello ea maikutlo, boits'oaro bo ts'oenyehileng le ntlha e behiloeng ea ts'ebetso ea khatello ea maikutlo ea neuroendocrine hypothalamic-pituitary-adrenal (HPA) Hlahisa et al., 2017;; bona hape Molina-Torres et al., 2019). Liphetoho ho physology e amanang le khatello ea maikutlo le boits'oaro bo fetotsoeng ke dysbiosis li ka hlaha ka lebaka la phetoho ea sebopeho sa likokoana-hloko ka ho pepesetsoa lithibela-mafu, lijo tse se nang phepo e ntle, ho hloka matsoele, ho tsoaloa ke karolo ea Cesarean, ts'oaetso, ho pepeseha ha khatello ea maikutlo le mabaka a mang a mangata a tikoloho (e hlahlojoang ka Hlahisa et al., 2017).

Bopaki ba bohlokoa bakeng sa mochine oa hypothesised pakeng tsa mathata a ho ja le microbiota bo fanoa ke ho fumana hore karolo ea 64% ea batho ba nang le bothata ba ho ja ba fumanoe ba e-na le bothata ba mala bo sa foleng.Perkins et al., 2005). Boithuto ba morao-rao bo fumane hore bakuli ba AN ba kheloha taolo ka bongata, phapang le karolelano ea kokoana-hloko ea fecal microbiota (e lekantsoe ho Schwensen et al., 2018), tse lulang li fapane haholo le tsa taolo e phetseng hantle esita le kamora ho phelisoa (Kleiman et al., 2015; Mack et al., 2016). Leha tse ling tsa phokotso ho Microbiota li ka bakoa ke ho ja - ka lijo tse fokolang tse fokotsang phapang ea likokoana-hloko (joalo ka ha li fumanoa lithutong tsa likokoana-hloko le batho: Krams et al., 2017; Stevens et al., 2019) - hape ho ka etsahala hore batho bana ba bile le kheloha microbiota pele ho moo. Boithuto ba morao-rao bo bonts'itse hore khatello ea kelello e senya gut microbiota (Gao et al., 2018; Partrick le al., 2018; Molina-Torres et al., 2019). Kahoo, khatello ea maikutlo e sa foleng e bakileng bothata ba ho ja e kanna ea fetola bakuli ba nang le bothata ba ho ja (cf. Seitz et al., 2019). Ka bomalimabe, lithuto tse mabapi le sebopeho sa likokoana-hloko tsa bakuli ba nang le BED le BN ha li sa fumaneha. Boithuto ba ho hlahloba bakuli ba tšoeroeng ke bothata ba ho ja ka nakoana bo ka ba bohlokoa haholo. Ho khahlisang, thuto e kholo ea Sweden (Hedman et al., 2019) e fumane hore kotsi ea lefu la celiac e eketsehile ka 217% nakong ea selemo sa pele kamora lefu la AN. Ka mokhoa o ts'oanang, lefu la Crohn le ne le atile ho feta ka makhetlo a mararo ho lefu la sethoathoa 'me ulcerative colitis e ne e atile haholo ho AN ho feta ho litekanyetso (Wotton et al., 2016). Kaha mafu ana a bakoa ke dysbiosis (mohlala, Ni et al., 2017), ho ata ha bona ho bakuli ba AN ho fana ka tšehetso e eketsehileng bakeng sa sehokelo pakeng tsa dysbiosis le AN.

Boithuto bo mabapi le litoeba tse se nang kokoana-hloko li bontšitse hore ho ba sieo ha bophelo ba bongoana ho lebisa tlhokomelong e kholo ea tryptophan ho plasma le ts'ebetso ea serotonergic bokongClarke et al., 2013). Liphetoho tsena li ka fetoloa ka ho fana ka litoeba ka libaktheria tsa probiotic tse tsejoang hore li susumetsa metabolism ea tryptophan (Clarke et al., 2013). Kakaretso, lithuto tse hlahlojoang ka holimo li bonts'a hore mathata a ts'ebetsong ea serotonergic mathateng a ho ja a kanna a bakoa ke ho kheloha ho leng ka mpeng ea micrutota. Re lumela hore ona ke mokhoa oa bohlokoa oa lithuto tsa nako e tlang (cf. Seitz et al., 2019), leha palo e kholo ea mosebetsi e ntse e hlokahala pele re tla ba boemong ba ho nts'etsapele liphekolo tse thehiloeng ho microbiome bakeng sa mathata a ho ja.

Mathata a ho ja jwaloka Continuum

Ke ntho ea bohlokoa, empa ea bohlokoa le e fumanehang lithutong tsa bongaka tse fumanehang hore basali ba fetang 50% ba fumanoe ba na le ANN BN (Bulik et al., 1997). Lebaka le leng le etsang hore phetoho ea BN e be hore ha boemo ba motho ba phepo bo ntse bo ntlafala, liphetoho tsa bona tsa ka mpeng li fetoha, tse ka bakang karabelo ea bona ea khatello ea maikutlo le ts'ebetso ea sistimi ea serotonergic. Hypothesis ena e tšehelitsoe ke lipatlisiso tse bonts'ang hore bulimic AN subtypes (AN-B) e fapana le mofuta oa AN (AN-R) ka sebopeho sa tikoloho ea likokoana-hloko (Mack et al., 2016), ha a ntse a thusa ho fetoha ho fetola kokoana-hloko ea malutla (Kleiman et al., 2015). Ntle le moo, kamora hore ts'ebeliso e ntlafalitsoeng e eketsehe ho tsepamiso ea tryptophan, likarabo tsa homeostatic tsamaisong ea serotonergic li ka lebisa nako le puso ho ea moo maemo a serotonin a fokotsehang haholo, mme ka nako eo a baka takatso ea ho itlopa lijo (cf.) Steiger et al., 2001).

Ho khahlisang, ha tlhahlobo ea meta e fumane hore bakuli ba AN ba ekelitse khatello ea cytokine ho plasma (haholo-holo IL-6 le TNF-α), maemo a cytokine ho bakuli ba BN a ne a sa fapana le taolo (Dalton et al., 2018). Lipatlisiso tsa liteko tsa liphoofolo tseo e seng tsa batho li fumane hore taolo ea li-cytokine tsa IL-6 li eketsa maemo a serotonin le ho fokotsa maemo a dopamine ho li-bokella tsa nyutlelie, phello e eketsoang ke khatello ea maikutlo (Pina et al., 1999). Motheong oa liphumano tsena, re nahana hore ha maemo a cytokine a theoha ho bakuli ba AN-R, ho ka baka phokotso ea litekanyo tsa serotonin ho fihla moo takatso ea ho itlopa lijo e hlahang, mme ka hona e fetole tlhahlobo ea bokuli ba mokuli ho AN-B . Hypothesis ena e tšehetsoa ke ho fumana hore bakuli ba AN-B ba na le boemo bo tlase ba ho ruruha ho feta bakuli ba AN-R (Solmi et al., 2015).

Ka kakaretso, mekhoa ena e arolelanoang e ka tlisoang ke mathata a ho ja e bontša hore mathata a ho ja hase mathata a arohaneng. Sebakeng seo, li bonahala li theha sebopeho, 'me li na le BED pheletsong e' ngoe ea pono le AN-R pheletsong e 'ngoe. BN le mofuta oa bulimic AN (AN-B) li teng lipakeng tsa maemo a feteletseng (Setšoantšo sa 2). Pele, pono ea transdiagnostic ea mathata a ho ja e ne e belaelloa (Birmingham et al., 2009), hanyane ka hanyane hobane karolo ea khatello ea maikutlo, neuroinfigueation le dysbiosis ho etiology ea mathata a ho ja e ne e sa utloisisehe. Mohlala o hlahisitsoeng sehloohong sena (Litšoantšo 1, 2) e fana ka maikutlo a hore ho fetoha ho matla ha tšoaetso, khatello ea maikutlo, litekanyetso tsa serotonin, ho tsepamisa mohopolo oa tryptophan le microbiota ho baka phetoho mekhoeng e litšila ea ho ja. Ha mekhoa ea ho nahana ka eona e boletsoeng ka holimo e kopantsoe le mofuta o tsoelang pele oa mathata a ho ja, re boemong bo botle haholo ba ho hlalosa hore na hobaneng ha matšoao a motho a fetoha khafetsa bothateng ba ho ja le hore na hobaneng bakuli ba ka fumanoa ba na le bothata bo bong ba ho ja.

Autoimmunity le Mathata a ho ja

Maemo ohle a litaelo tsa ho ja ha a hlile ha a bakoe ke tlholisano e kenelletseng ea botenya. Mohlala, ho na le bakuli ba AN ntle le tšabo e kholo ea ho nona kapa ho nona. DSM-V (Mokhatlo oa Mahlale oa Amerika, 2013e hlahisitse tlhahlobo ea tlhahlobo ea lihlahisoa tsa mafu (ARPA) (Thibelo ea Thibelo ea ho Qoba / e thibelang) ho hlalosa bakuli ba fokolang ba sa tšoaroeng ke setšoantšo sa 'mele (ke hore, non-fat-phobic AN). ARFID e bonahala e atile haholo linaheng tse ntseng li tsoela pele ho feta mafura-phobic AN, e atileng haholo linaheng tse tsoetseng pele (e hlahlojoa ho Becker et al., 2006). Ka mokhoa o ts'oanang, le ha mathata a ho ja a atile haholo har'a batho ba bong bo fapaneng ho feta banna ba bong bo fapaneng.Li et al., 2010; Calzo et al., 2018), mathata a ho ja a etsahala ho banna ba bang ba bong bo fapaneng. Sena se ka ba thata ho se hlalosa ka tlholisano e makatsang bakeng sa botenya hobane botenya ha bo bohlokoa joalo ho khethoe ke basali joalo ka banna (Li et al., 2010).

Haeba neuroinflammation e bapala karolo ea bohlokoa ho AN, potso ea bohlokoa ke hore na ke eng e bakang ho ruruha maemong aa? Ka tlhaho, khatello ea maikutlo e sa foleng e hlahisang neuroinflammation e ka bakoa ke lintlha tse ling ntle le tlholisano e kenang. Sena se ka ba joalo haholo ho bakuli ba se nang mafura-phobic AN. Ntle le khatello ea maikutlo e sa foleng, neuroinfigueation e ka boela ea bakoa ke mafu a autoimmune le autoinflammatory (Najjar et al., 2013). Ka mokhoa o ts'oanang, ho na le litlaleho tse ngata tsa linyeoe tseo ho tsona AN a tšoaelitsoeng ke ts'oaetso: linyeoe tsena li hlalositsoe e le "autoimmune anorexia nervosa" (Sokol le Grey, 1997; Sokol, 2000). Maemong a mang, OCD e hlokometsoe hore e latela ts'oaetso (Mokhatlo oa Mahlale oa Amerika, 2013), e fanang ka tšehetso e eketsehileng bakeng sa kopano pakeng tsa ts'ebetso ea ho itšireletsa mafung le tšimoloho ea OCD le AN (Setšoantšo sa 1). Feela joalo ka bakuli ba mafura-phobic AN, bakuli ba se nang mafura-phobic AN ba ka ithuta ho fokotsa ho tšoenyeha ka ho ja. Sena se ka lebisa ho khatello e matla ea khatello ea kelello / potoloho ea tlala joaloka le mafura a phobic AN (Setšoantšo sa 1). Ntle le moo, mohlala oa rona oa psychoneuroimmunological o fana ka tlhaloso hape bakeng sa linyeoe tseo tsa nalane ea non-fat-phobic anorexia mothosa e neng e le teng mekhatlong ea nalane e neng e sena botle bo bobebe (cf. Arnold, 2013).

Phuputsong e kholo ea sechaba ka bophara e entsoeng Denmark, Zerwas et al. (2017) e fumane hore mafu a autoinflammatory kapa autoimmune a eketsa kotsi bakeng sa AN ka 36%, BN kotsing ka 73% le bothata ba ho ja bo sa boletsoeng ka mokhoa o mong (EDNOS) kotsing ka 72%. Phello ena e ne e le matla ho bashanyana ho feta ho banana (Zerwas et al., 2017). Bakeng sa bashanyana, ho ba le kotsi efe kapa efe ea autoinflammation ho ekelitse kotsi ea EDNOS ke 740%. Phuputso e kholo ea Sweden e tlalehile hore mafu afe kapa afe a pejana a autoimmune a eketsang kotsi ea AN ka 59% (Hedman et al., 2019). Boithuto bo bong bo boholo bo neng bo sekaseka kamano ea liphatsa tsa lefutso lipakeng tsa mathata a ho ja le mafu a autoimmune ha boa ka ba supa phapang e teng lipakeng tsa liphatsa tsa lefutso pakeng tsa mafu a anorexia nervosa le autoimmune (Tylee et al., 2018). Sena se fana ka maikutlo a hore tikoloho eseng lintho tsa liphatsa tsa lefutso e baka kamano lipakeng tsa mafu a AN le a autoimmune.

Re fetolela liphumano tsena re fana ka tšehetso e pharalletseng ea mohlala oa rona oa psychoneuroimmunological bakeng sa mathata a ho ja ka mabaka a mane: (1) khatello ea maikutlo e sa foleng e tsejoa ho baka mafu a autoimmune (Pina et al., 2018), (2) mafu a mangata a autoinfigueatory le autoimmune a tsejoa ho eketsa neuroinfranceation (Najjar et al., 2013), (3) ts'ebetso ea sesole sa 'mele e tsebahala ka ho eketsa khatello ea maikutlo (Yau le Potenza, 2013), le (4) dysbiosis ka gut microbiota e ka lebisa ho qaleheng ha maloetse a amanang le lefu la sethoathoa (Lukens et al., 2014). Joalokaha ho hlahlojoa khaolong ea "Neurochemistry of Anorexia Nervosa and Bulimia Nervosa", dysbiosis e boetse e tloaelehile mathateng a ho ja.

Kahoo, boemong ba ARFID (e se nang mafura-phobic AN), batho ba nang le neuroinfigueation ba ka ithuta hore ho ja le ho itima lijo ho ka fokotsa khatello ea maikutlo le dysphoria hobane ho ja le ho itima lijo ho fokotsa likarabo tsa autoimmune (cf. Hafstrom et al., 1988) le ho nyenyefatsa tsamaiso ea serotonergic (cf. Kaye et al., 2009), e lebisang kemisong e mpe ea ho ja le ho qetella e le AN. Mokhoa ona oa psychoneuroimmunological o ka hlalosa hore na ke hobaneng ha banna ba bong bo fapaneng le ba monna a le mong ka linako tse ling a tšoeroe ke AN (cf. Carlat et al., 1997) leha tlholisano e matla ea ho ba mosesaane e le sieo ka tekanyo e ts'oanang le ea basali ba bong bo fapaneng (cf. Abed et al., 2012).

Comorbidity ea Mathata a ho ja

Mathata a ho ja hangata a na le sekhahla se phahameng sa ho ferekana le mathata a mang a kelello (Keski-Rahkonen le Mustelin, 2016). Mohlala, bakuli ba 93-95% ea bakuli ba AN ba ne ba e-na le lefu la ho feto-fetoha ha maikutlo ka bongata, 55-59% ba na le khatello ea maikutlo 'me 5-20% ba ne ba e-na le bothata bo amanang le ntho e itseng (Blinder et al., 2006). Patlisiso mabapi le comorbidity ea mathata a kelello ho BN e bonts'itse hore 94% ea bakuli ba BN ba baholo ba ne ba na le bothata ba ho feto-fetoha ha maikutlo, 55% ba na le bothata ba ho tšoenyeha 'me 34% e na le bothata ba tšebeliso ea lithethefatsi (Swanson et al., 2011). Li-Comorbidities li ne li sa atamele ho bacha ba nang le BN: 49.9% e ne e na le lefu la ho feto-fetoha ha maikutlo, 66.2% e bile le khatello ea maikutlo, tšebeliso ea lithethefatsi e etsahetse ho 20.1% ea bacha ba BN ha 57.8% e bile le bothata ba boitšoaro (Swanson et al., 2011).

Hobane BED e sa tsoa khethoa e le pherekano e arohaneng, lithuto tse mabapi le likotsi tsa kelello tsa kelello li haella (cf. Olguin et al., 2017). Phuputso e kholo ea lefu la seoa ho bacha ba US e fumane hore 45.3% ea batho ba nang le BED ba na le lefu la ho feto-fetoha ha maikutlo a pelo, 65.2% ba na le khatello ea maikutlo, tšebeliso e mpe ea lithethefatsi e etsahetse ho 26.8% ea bacha ha ba 42.6% ba e-na le bothata ba boitšoaro (Swanson et al., 2011).

OCD, e arolelanang lits'oants'o tse ngata le mathata a ho ja, e amahantsoe le bothata ba dysregulation ba makhopho (Turna et al., 2017) le mosebetsi o fetotsoeng oa serotonin bokong (Lissemore et al., 2018). Feela joaloka mathata a ho ja, OCD e amahanngoa le ho hlonama ho phahameng le mathata a mang a kelello (Hofmeijer-Sevink et al., 2013). Kaha gut microbiome dysregulation le khatello ea maikutlo e sa foleng ka bobeli li tsamaisana le ho feto-fetoha ha maikutlo le khatello ea maikutlo (e hlahlojoang ka Bekhbat le Neigh, 2018; Liang et al., 2018), Tlhaloso e hlakileng ka ho fetisisa ea ho hlaha hoa li-comorbidities ke hore ho OCD le mathata a ho ja, li-comorbidities tsena li bakoa ke dysbiosis le maikutlo a phahameng a ho imeloa kelellong.

Habohlokoa, matšoao a mangata a AN a bonahala e le matšoao a tlala, eseng la bothata ba kelello. Mohlala, thutong e tummeng ea tlala ea Minnesota, banna ba 36 ba phetseng hantle ba ne ba bolaoa ke tlala ea likhoeli tse 6 (Linotlolo, ka 1950). Ka mor'a moo banna ba ile ba qala ho bontša matšoao a tšoanang le mathata a ho ja, joalo ka tloaelo ho ja, ho ameha ka lijo le ho ja. Banna ba bolailoeng ke tlala ba boetse ba tloaetse ho ts'oara mekhoa e metle ea ho bokella, ba fana ka maikutlo a hore ho bolaoa ke tlala ho ka baka kapa ho tiisa matšoao a tšoanang le a Osele a Boreleli. Banna ba bang ba lapileng ba ne ba tloaetse ho bala libuka tsa ho pheha, ba lora ka lijo 'me ba lula ba bua ka tsona (Linotlolo, ka 1950). Ho ts'oenyeha ho joalo ka lijo ho atile ho bonoang ho bakuli ba AN (Khabareng, 1983).

Banna bao ba neng ba bolailoe ke tlala hape ba ile ba teneha, ba tšoenyeha le ho tepella maikutlo, e leng ho bolelang hore tlala e ile ea lebisa ho tepelletseng ho bolailoeng ke tlala (cf. Rantala et al., 2018). Lithutong tse ngata, matšoao a ile a boela a hlaha kamora ho pepa. Likarolo tsa tlala ea nako e telele e lebisa ho iphapanyetsano le ho tlosoa sechabeng (cf. Linotlolo, ka 1950), tseo hape e leng matšoao a tloaelehileng a AN. Phuputso ea ho bolaoa ke tlala ea Minnesota e bontšitse hore hang ha tlhahlobo ea tlala e felile, banna ba bangata ba ile ba bontša ho tšoenyeha ka ho nona haholo le "ho ba bohlasoa" (Linotlolo, ka 1950). Mehlala e ts'oanang e ka fumanoa litlalehong tsa linyeoe le lilulo nakong ea tlala (Linotlolo, ka 1950). Leha a ne a holofetse, banna ba bangata ha ba ka ba ipona ba le boima ba mmele (Linotlolo, ka 1950). Ka hona, ho bonahala eka ho bolaoa ke tlala ho ka matlafatsang setšoantšo se fosahetseng sa sebopeho sa AN le hore tlala ka boeona e baka mofuta oa psychopathology e bonoang ho bakuli ba AN.

Lintho Tse Kotsi Bakeng sa Mathata a ho ja

Lintlha tsa liphatsa tsa lefutso le Neuroinfigueation

Lithuto tsa malapa, tsa mafahla le tsa ho amohela bana li bontšitse khafetsa hore lintlha tsa liphatsa tsa lefutso li kenya letsoho phapanyetsanong ea mathata a ho ja. Likhakanyo tsa Heritability bakeng sa BED pakeng tsa 41 le 57%; Likhakanyo tsa heritability ea BN li pakeng tsa 30 le 83%, athe AN e na le heritability ea 28-78% (Thornton et al., 2011). Mathata a ho ja ke a leloko: Beng ka basali ba batho ba nang le AN ke makhetlo a 11.3 a nang le monyetla oa ho hola AN ho feta ba lelapa la batho ba se nang AN; Beng ka basali ba batho ba nang le BN ke menyetla ea 12.3 ea ho theha BN ho feta batho ba amanang ntle le BN (Strober et al., 2000). Ho na le mabaka a fokolang a lefutso a khetholloang ka botlalo bakeng sa mathata a ho ja (a lekantsoe ho Mayhew et al., 2018), leha lipatlisiso tsa morao-rao li bonts'itse li-loci tse robeli tsa motheo tsa AN etiology, ho fana ka maikutlo a tšimoloho ea methapo le kelello bakeng sa lefu lena (Watson et al., 2019). Liphuputso tsa Twin li senotse hore ho na le phetisetso e arolelanoang pakeng tsa mathata a ho ja le mathata a ho tšoenyeha (Keel et al., 2005), lipakeng tsa AN le OCD (Altman le Shankman, 2009) le lipakeng tsa BN le ho tšohaKeel et al., 2005). Tlhaloso e kholo ka ho fetisisa bakeng sa liphumano tsena ke hore phetisetso e arolelanoang e bakoa ke ho ba monyetleng oa ho fana ka ts'usumetso ea khatello ea maikutlo le khatello ea maikutlo, joalo ka ha ho fanoe ka bopaki bo hlahliloeng ka holimo. Kotsi ena ea ho ba le neuroinfigueation le khatello ea maikutlo li ka hlalosa lebaka leo lithuto tsa GWAS li fumaneng kamano ea liphatsa tsa lefutso lipakeng tsa AN le mafu a mang a mangata a kelello joalo ka schizophrenia, khatello e kholo ea khatello ea maikutlo, ho ferekana ha kelello le ho ferekana kelellong (autism)Antila et al., 2018; Sullivan et al., 2018), hobane neuroinflammation e nka karolo ho tsona kaofela (Najjar et al., 2013). Hammoho le liphapang tsa sebopeho sa microbiome, liphihlelo tsena tsa liphatsa tsa lefutso ho neuroinfigueation ka karolo li ka hlalosa hore na tlholisano ea boteng e lebisa ho BED, BN kapa AN (cf. Setšoantšo sa 2).

Tlhekefetso ea bongoana, khatello ea maikutlo, Epigenetics le Microbiota

Ho hlekefetsoa ha ngoana ka tsela ea tlhekefetso ea thobalano, maikutlo le 'mele ho eketsa menyetla ea mafu a amanang le phepo (e hlahlojoang ka Hoppen le Chalder, 2018). Ho hlekefetsoa ha ngoana bongoaneng ho eketsa menyetla ea ho ba le bothata ba ho ja ka makhetlo a fetang a mararo (Caslini et al., 2016). Ho hlekefetsoa ha ngoana bongoaneng ho eketsa karabelo ea khatello ea maikutlo ha motho e le motho e moholo, sephetho se tsamaisoa ka mokhoa o fapaneng ke mekhoa ea epigenetic e joalo ka DNA methylation (DNAm) ea mofuta oa axis ea HPA (Bustamante et al., 2016). Matšoenyeho a sa feleng bongoaneng a ka ama likokoana-hloko ka tsela e tla hore kokoana-hloko e fetotsoeng, e bitsang motho e mong e qobelle batho hore ba be le khatello ea maikutlo (O'Mahony et al., 2016). Ntle le maikutlo a eketsehang a khatello ea maikutlo, khatello ea bophelo ba bongoaneng e ka baka microglia, e ka lebisang karabong e ka hlahisang karabo ea khatello ea kelello ho khatello ea kamora e latelang (e hlahlojoang ka Calcia et al., 2016). Ho sithabela maikutlo ho sa foleng ho tlalehiloe khafetsa ka selemo pele ho ho qaleha ha AN lithutong tsa mafu a seoa (Rojo et al., 2006). Bakuli ba tlalehile maemo a phahameng a khatello ea bophelo bohle le mathata a mangata a ho sebetsana le khatello ea maikutlo ho feta taolo e phetseng hantle (Soukup et al., 1990). Liphuputso tse fumanehang hape li fumane hore khatello ea maikutlo e matla ea bophelo e fapana lipakeng tsa sampuli ea AN le taolo, ho bolela esale pele qaleho ea AN ho 67% ea linyeoe (Schmidt et al., 2012).

Karolo ea Hormone ea Thobalano

Litekanyetso tsa li-hormone tsa botona le botšehali ho bonahala li na le tšusumetso ea hore na tlholisano e kenelletseng ea botona e lebisa mathateng a ho ja. Lihormone tsa thobalano le tsona li susumetsa mofuta oa bothata ba ho ja bo ntlafalitsoeng (Setšoantšo sa 2). Estrogen e tsejoa ho khothaletsa ts'ebetso ea HPA, ka tsela eo e eketsa karabelo ea khatello ea maikutlo (Kudielka le Kirschbaum, 2005). Androgens, ka lehlakoreng le leng, e tloaetse ho fokotsa ts'ebetso ea HPA mme ka tsela eo e fokotsa ho arabela ha khatello ea maikutlo (Kudielka le Kirschbaum, 2005). Hangata banna ba bonts'a ts'ebetso e phahameng ea HPA maemong a amanang le maemo ha basali ba bonts'a ts'ebetso e phahameng ea HPA maemong a kenyelletsang ho khesoa sechabeng (ho hlahlojoa ka Del Giudice et al., 2011).

Ka hona ho ka boleloa esale pele hore basali ba bangata ba batšehaliBártová et al., 2020), ke ho re, basali ba nang le ponahalo e phahameng ea prenatal androgen kapa maemo a holimo a testosterone a joale (Luoto et al., 2019a, b- - 'me, ka hona, khokahano e phahameng ea maemo a sechaba (cf. Nave et al., 2018) - Ho ba le menyetla e phahameng ea ho holisa AN. Ho fapana le hoo, basali ba eketsehileng ba basali ba amehang haholo ka ho khesoa sechabeng ba ka lebelloa ho ba le kotsi e kholo ea ho hlaha BED. Ka 'nete, karolelano ea linomoro (2D: 4D, ke hore, tlhahlamano ea lihlahisoa tsa prenatal androgen: Luoto et al., 2019a) e sebetsa haholo ho bakuli ba AN ho feta ho bakuli ba BN, ba nang le litekanyetso tse nang le karolelano ea lipalo tse mahareng (Quinton et al., 2011). Sena se fana ka maikutlo a hore bakuli ba AN ba ka be ba bile le ponaletso e phahameng ea prenatal androgen ho feta bakuli le taolo ea (bakeng sa puisano e qaqileng ea mekhoa ena ea ntlafatso bathong bao e seng ba bongaka, bona. Luoto et al., 2019a, b). Ho basali, litekanyetso tse tlaase tsa testosterone ea prenatal le li-hormone tsa "ovary" tse phahameng tsa "pubertal" li bonahala li eketsa kotsi ea BED; ho banna, litekanyetso tsa testosterone e phahameng ea bokhachane ho bonahala li sireletsa khahlanong le BED (Klump et al., 2017). Liphumano tsena li bonts'a karolo ea lihormone tsa thobalano ka phapang ea phenotypic (Setšoantšo sa 2) le phapang ea botona le botšehali mathata a ho ja.

Kalafo ya hona joale ea mathata a ho ja

Phekolo ea mathata a ho ja ha e na thuso haholo ho feta kalafo ea mafu a mang a kelello. Ke 46% feela ea bakuli ba AN ba fola ka ho felletseng, karolo ea boraro e hlaphoheloa ka karolo e itseng mme ho 20% AN e sala e le boemo bo sa foleng (Arcelus et al., 2011). Nako e tloaelehileng ea bokuli ke lilemo tse 6 (Schmidt et al., 2016). Hajoale, ha ho na kalafo e sebetsang ea meriana ea meriana. Likhetho tse khethiloeng tsa li-serotonin reuptake inhibitors (SSRIs) ha li na thuso bakeng sa AN (Davis le Attia, 2017). Ha ho na moriana o lumelletsoeng oa ho phekola anorexia mothosa ea Amerika kapa EU (Bodell le Keel, 2010; Starr le Kreipe, 2014). Kalafo ka hona e ipapisitse le mefuta e fapaneng ea kalafo le boiteko ba ho khutlisa boima (mohlala, Brockmeyer et al., 2017; Harrison et al., 2018 le litšupiso ho eona). Ho sebetsa hantle ha kalafo e thehiloeng ka lapeng ho tlalehoa ho phahame ho feta mefuta e meng ea psychotherapy (Starr le Kreipe, 2014).

Phekolo ea mantlha ea BN ke tlhahlobo ea kelello ea boits'oaro (CBT) e ikemiselitseng ho fetola mekhoa e mebe e tlatselletsang ho itlopa lijo ha o ntse o leka ho fokotsa boits'oaro ba ho ja (Fairburn, 2008). Li-SSRIs li hatella mokhoa o batang oa ho ja empa u se ke oa li felisa (Mitchell et al., 2013). Sekhahla sa ho theoha kalafo ea meriana e thibelang mafu ho bakuli ba BN se haufi le 40% (Bacaltchuk le Hay, 2003). Phekolo ea hona joale ea BN ha e sebetse ka ho khetheha: lithuto tsa ho latela li bontšitse hore ka nako ea lilemo tse 10, ke bakuli ba 50% ba hlaphoheloeng ka botlalo (Hay et al., 2009).

Boholo ba litlhare ba sebetsa hantle ka tsela e ikhethileng khahlano le linako tsa ho itlopa lijo ka nako e khuts'oane, empa katleho ea bona ea nako e telele ha e tsejoe (McElroy et al., 2012). Ntle le moo, ha li thusa ho theola boima ba 'mele ebile ha li bonahale li ntlafatsa litlamorao tsa ho ja li-CBT (McElroy et al., 2012). Li-antipsychotic tsa moloko oa bobeli tse sebelisoang liphekeng tsa AN ha e le hantle li kenya kapa li eketsa ho itlopa lijo ho bakuli ba nang le BED le BN (McElroy et al., 2012; Cuesto et al., 2017). Liteko tse laoloang habeli le tse sa laoloeng ke maloetse li bontšitse hore moemeli oa anti-epileptic, topiramate, oa sebetsa khahlano le likotsi tsa ho itlopa lijo ka BED ka botenya. Topiramate e na le thepa e phahameng e khahlanong le ho ruruha, 'me e bontšitsoe ho fokotsa khatello ea kelello le khatello ea methapo ho likhoto (Pinheiro et al., 2015). E boetse e bontšoa hore e boloka tšebeliso e matla ea tahi e bakiloeng ke khatello ea litoeba (Farook et al., 2009), ho fana ka maikutlo a hore e ka fokotsa khatello ea khatello ea maikutlo. Ho khahlisang ke hore topiramate e boetse e fokotsa ka katleho litlatsetso ho OCD (Rubio et al., 2006; Van Ameringen et al., 2006; Mowla et al., 2010; Berlin et al., 2011). Ka bomalimabe, topiramate ha e ea lokela ho ba kalafo bakeng sa AN kapa bakeng sa bakuli ba nang le nalane ea AN hobane topiramate e fokotsa takatso ea lijo mme e ntlafatsa tahlehelo ea boima ba 'mele joalo ka litlamorao. E kanna ea kenya motho ho ba nang le mabaka a tsebahalang a kotsing ea AN (Lebow et al., 2015). United States le Canada, setlhare feela se amoheloang bakeng sa BED e leka-lekaneng le e matla ke lisdexamxamfetamine, le sona se sebelisitsoeng ho phekola bofokoli ba ho fokola ba kelello (ADHD) (Heo le Duggan, 2017). Liteko tse sa sebetsoang ka mahlo a mabeli tse sa bonts'itsoeng li bonts'itse hore lisdexamfetamine e sebetsa hantle haholo khahlano le ho ja ho itlopa joala ho feta placebo. Leha ho le joalo, lisdexamfetamine e na le litlamorao tse mpe joalo ka molomo o omileng, hlooho e bohloko le ho hlobaela ho lebisang ho khaoleng hoa lithethefatsi ho bakuli ba bangata (Heo le Duggan, 2017). Ntle le moo, e kokobetsa matšoao ho fapana le ho tlosa bothata bo bakang bokuli, kahoo e fana ka tharollo ea nako e telele ea nako e telele (cf. Rantala et al., 2017).

Litlhare tsa ho ja mathata a ho ja ho ipapisitse le Psychoneuroimmunology

Moetso oa psychoneuroimmunological oo re o hlahisitseng o na le monyetla oa ho ntlafatsa katleho ea kalafo ea mathata a ho ja. Mohlala o fana ka maikutlo a hore, ho fapana le ho fana ka kalafo e thehiloeng lelapeng le kalafo ea kelello bakeng sa bakuli ba AN, ho ka ba molemo ho feta ho leka ho fokotsa khatello ea maikutlo ho fokotsa boima ba 'mele le khatello ea maikutlo e sa foleng. Re boetse re khothaletsa hore CBT e thehiloeng ho ts'ebetso ea kelello ea phetolo ea kelello e ka thusa ho fetisa maikutlo a bakuli le maikutlo a bona a botle bo bobe ho leba tseleng e phetseng hantle. Ka mokhoa o makatsang, mohlala oa rona oa psychoneuroimmunological o fana ka maikutlo a hore liphetoho tsa mokhoa oa bophelo tse fokotsang neuroinflammation le khatello ea maikutlo li lebelletsoe ho fokotsa matšoao a AN, leha ho le joalo lithuto tse ling tsa kliniki li hlokahala hore sena se netefatsoe ka matla.

Tlhahiso ea meriana bakeng sa AN e ka lebisang Neuroinflammation

Boithuto ba morao-rao bo bontša hore kalafo ea olanzapine (lithethefatsi tsa atypical antipsychotic) e lebisa ho phaello e kholo ea bakuli ba nang le AN (Dold et al., 2015; Himmerich et al., 2017). Boithuto ho litoeba bo bontšitse hore olanzapine e fokotsa neuroinfranceation (Sharon-Granit et al., 2016). E hatella TNF-α le IL-6 hape e eketsa maemo a IL-10, e leng cytokine e thibelang mafu (Sugino et al., 2009). Kahoo, mochine o ka sebelisoang oa hore olanzapine e thusa bakuli ba AN a ka fokotsoa keurouro, leha sena se ntse se lokela ho netefatsoa ka matla.

Liphuputso li bontša phello e ntle ea kalafo e khahlanong le TNF-α ho AN (Solmi et al., 2013). Esalatmanesh et al. (2016) e fumane hore motsoako oa minocycline o tsejoang ka litšobotsi tsa ona tsa ho loants'oaetso o fokolitse haholo matšoao a OCD ho bakuli ba OCD ntle le ho baka litlamorao tse mpe.

Zinc, Anorexia Nervosa le Neuroinflammation

Bopaki bo tsoang liphuputsong tsa bongaka bo bontša hore bakuli ba AN ba na le li-zinc tsa zinc tsa zinc tse tlase le litheko tse tlase tsa urine zinc excretion (Katz et al., 1987). Botebo ba khaello ea zinki bo amahanngoa le ho teba ha AN, hammoho le maemo a phahameng a khatello ea maikutlo le matšoenyeho (Katz et al., 1987). Liteko tse 'maloa tse laoloang ka mokhoa o ikhethileng oa tlatsetso ea zinc li tlalehile keketseho e kholo ea boima ba lithuto (Safai-Kutti le Kutti, 1986; Safai-Kutti, 1990; Birmingham et al., 1994; Birmingham le Gritzner, 2006). Khaello ea Zinc e tsejoa ho amahanngoa le tlhahiso e eketsehang ea li-cytokine tsa proinflammatory, haholo-holo TNF-α le IL-6 (Gammoh le Rink, 2017). Kahoo, re fana ka maikutlo a hore mochine o ka khonehang lipakeng tsa tlatsetso ea zinc le phokotso ea matšoao a AN le ho nona boima ba 'mele li ka sebetsa ka ho fokotsoa ke neuroinfigueation. Fokotsa neuroinfigueation, le eona e fokotse mahlo. Tlhatlhobo ena e ts'ehetsoa ke lipatlisiso tsa liteko tse laoloang ke placebo tse tlalehang hore maikutlo a mabapi le ho ja le lijo a ntlafala haholo ho bakuli ba ileng ba ja lipilisi tsa zinc (ho fapana le ba fumaneng lipilisi tsa placebo) (Khademian et al., 2014). Kahoo, ho bonahala eka zinki e fokotsa matšoao a OCD ho bakuli ba AN. Ho khahlisang, li-supplement tsa zinc li fokotsa matšoao le ho bakuli ba nang le OCD ba se nang mathata a ho ja (Sayyah et al., 2012). Ka kakaretso, ho hlokahala lipatlisiso tse eketsehileng ho utloisisa mochine (s), oo zinki e susumetsang matšoao a AN ka oona.

Ntle le zinc, micronutrients tse ling li ka sebelisoa ho fokotsa neuroinflammation. Mohlala, bakuli ba AN ba na le khaello ea vithamine D (Veronese et al., 2015; Tasegian et al., 2016) le tlatsetso ea vithamine D e tsejoa ho fokotsa ho ruruha (Grossmann et al., 2012; Zhang et al., 2012; Berk et al., 2013) hammoho le neuroinfigueation (Koduah et al., 2017).

Fecal Microbiota Transplantation le Probiotic

Haeba tsoelo-pele ea saense e ntse e tsoela pele ho fana ka tšehetso e matla bakeng sa karolo ea Microbiota ho etiology ea mathata a ho ja, ho ka etsahala hore li-transecter tsa fecal tse tsoang ho batho ba phetseng hantle e tla ba karolo ea kalafo ea kalafo ea nakong e tlang ea mathata a ho ja. Phuputso ea pele e phatlalalitsoeng (de Clercq le al., 2019) e tlaleha phaello e kholo ea boima ba 'mele kamora ho fetisoa ha fecal microbiota ho mokuli ea nang le AN. Leha ho le joalo, lipatlisiso lefapheng lena li sa le monyane. Ntle le phetisetso ea fecal Microbiota, makhopho a tsoang ka mpeng a ka 'na a sebelisa meriana le liprotheine tse ling (Stevens et al., 2019). Ka bomalimabe, leha bopaki bo bokelletsang bo fana ka maikutlo a hore li-probiotic ke kalafo e tšepisang ea ho fokotsa ts'ebetso ea ts'oaetso e fumanoang mofuteng o moholo oa khatello ea maikutlo (e hlahlojoe ho Park et al., 2018), lithuto tsa ho sebetsa hantle ha li-probiotic kaha kalafo ea bothata ba ho ja e ntse e fokola.

Binge Eating Disorder (BED) kalafo e thehiloeng ho Evolutionary Psychiatry

Phekolo ea BED e thehiloeng ho ts'ebetso ea kelello ea phetoho e lokelang ho fetoha, ka pono ea rona, e lokela ho shebana le ho emisa potoloho e mpe ea liteko tsa ho ja tseo mafura a itlotsang ho ja. Bakuli ba lokela ho leka ho theola boima ba 'mele ka ho ja hantle le ho ikoetlisa (cf. Lindeberg, 2010; Temko et al., 2017; Leone et al., 2018) ho fapana le ho leka ho fokotsa ho ja likhalase ka ho itima lijo. Mokhoa ona o ts'oana haholo le oa kalafo oa hajoale oa CBT oa BED (cf. Hilbert, 2013). Lijo tse nang le phepo e ntle li ka thusa ho fokotsa boikarabello ba bakuli ba BED: lithuto tsa liteko ho liphoofolo li bontšitse hore mala a microbiota a susumetsa karabelo ea khatello ea maikutlo (Bravo et al., 2011). Ntle le moo, lijo tse nang le phepo e nepahetseng, haholo li-omega-3 tse mafura le li-polyphenols, li fokotsa ho ruruha (Ricordi et al., 2015), e tsejoang ho khothaletsa ts'ebetso ea HPA (Yau le Potenza, 2013; Mosebetsi, 2019) le ho senya boitaolo ba ho itaola (Shields et al., 2017). Ho ikoetlisa ho ka thusa ho fokotsa khatello ea maikutlo (cf. Zschucke et al., 2015). Ho sebetsa ha likhetho tsena tsa kalafo ea BED ho lokela ho khethoa lithutong tsa kliniki tsa nako e tlang.

Thibelo ea mantlha ea ho ja mathata a ho ja

Phekolo ea kaholimo e tsepamisa mohopolo lits'ebetsong tse amanang le ho ja; leha ho le joalo, hore kalafo efe kapa efe e ka ba le katleho e telele ea nako e telele, qholotso ea mantlha ea mathata a ho ja le eona e lokela ho rarolloa. Mananeo a ho bala le ho ngola a mecha ea litaba a ka theha mohato o sebetsang oa thibelo bakeng sa mathata a ho ja (Li et al., 2014) tse betliloeng joalo ka litšoantšo tse hlakileng tsa basali ba basesane le banna ba mesifa mecheng ea litaba ba hlohlelletsa merero ea tlholisano e makatsang (Bootroyd et al., 2016; Borau le Bonnefon, 2017; Saunders le Eaton, 2018), hape ha ho na taba hobane ho le thata hore bacha ba fokotse ho pepeseha ha bona mecheng ea litaba. Mananeo a ho bala le ho ngola a media a ikemiselitse ho etsa hore barupeluoa ba tsebe basebelisi ba litaba. Li kenyelletsa likarolo tsa psychoeducational mme li bonts'a hore na software e hlophisitsoeng e sebelisoang joang ho etsa hore litšoantšo li shebahale li "phethahetseng" (Li et al., 2014). Mananeo a ho tseba ho bala le ho ngola a thehiloe khopolong ea hore ka ho fa bacha lintlha mabapi le papatso le litšoantšo tsa media, ba ke ke ba angoa habonolo ke ho kenya litabatabelo tsa 'mele kahare mme ba sa amehe ka boima ba tsona: ka lebaka leo, boitšoaro bo amanang le mathata a ho ja bo tla fokotsoa. (Li et al., 2014).

Mananeo a ho bala le ho ngola a mecha ea litaba a atlehile ho fokotsa maemo a amanang le ho kula a amanang le mathata a ho ja. Phuputso e entsoeng ho baithuti ba pele ba fetisitsoeng sekolong e tlaleha hore ts'ebetso ea ho bala le ho ngola ea libeke tse 'nè e fokotse ho se khotsofale ha' mele le ho tsepamisa maikutlo menahanong ea setsoalle sa botonaWatson le Vaugn, 2006). Phuputso e 'ngoe e fumane hore ho nka karolo lenaneong la borobeli la ho bala ho bala le ho ngola ho fokotsitse sebopeho, boima le mathata a ho ja le ho se khotsofale ha' mele ho banana ba lilemong tsa bocha - phello e ile ea pheella ho lateloa ha likhoeli tse 30, ho fana ka tlhahiso ea ntlafatso ea nako e telele (Wilksch le Wade, 2009). Ntle le thuto ea bongoli ba litaba, mekhoa e thehiloeng ho dissonance, eo barupeluoa ba koetliselitsoeng ho nka maikutlo a khahlanong le litakatso tsa botle bo fokolang, ba atlehile ho fokotsa boitšoaro le menahano e amanang le mathata a ho ja (Stice et al., 2001, 2006; Becker et al., 2006; Yager le O'Dea, 2008). Li et al. (2014) o khothalelitse hore motsoako oa mananeo a ho bala le ho ngola a mecha ea litaba e ka ba tsela e atlehang ea ho thibela mathata a ho ja ho bacha.

fihlela qeto e

Bopaki bo fetolang bo bonts'a hore mathata a ho ja hangata ke likarabo tse sa lokang ho tlholisano e kenelletseng ea bothateng. Mismatch hypothesis e hlalositsoeng Karolong ea "Mismatch Hypothesis of Eating Dis shida" e boetse e hlokomela hore maemo a iphetotseng a lijo le bophelo ba ho lula feela bo hlahisa maemo metaproblem e sebetsang moo methapo ea kelello ea lijo e jang likhohlano le mekhoa ea kelello e amanang le ho hola. Keketseho e kholo ea mathata a ho ja ho batho ba sejoale-joale ke ntho e iqapetsoeng: litho tsa mefuta e meng ha li tsejoe ba ipolaise ka tlala ka lebaka la nala ea lijo. Ena ke ntlha e makatsang bakeng sa kelello ea kelello e nang le tsebo.

Bopaki bo hlahlojoang lengolong lena bo re lebisitse hore ho e-na le ho nahana hore mathata a ho ja e le maemo a hlakileng, a lokela ho talingoa ka mokhoa o tsoelang pele. Ho latela mohlala oa psychoneuroimmunological oo re o hlahisitseng sehloohong sena, phapang ea mathata a ho ja e ka hlaha ho tsoa ho phapang e le 'ngoe ka boteng ba mala le karabelo ea khatello ea maikutlo (Setšoantšo sa 2), e susumetsang neuroinfigueation le tsamaiso ea serotonergic (Setšoantšo sa 1). Moetso oa rona oa maiketsetso o fana ka likarabo tsa lipotso tse 'ne tse phehellang: (1) hobaneng matšoao a ho khetholla le mekhoa e amanang le ena e feta haholo likarolong tsohle tsa mathata a ho ja, (2) hobaneng ho hlahloba mathata a ho ja ho le thata, (3) hore na hobaneng ho hlahloba mafu ho ka fetoha lipakeng tsa mathata a ho ja Nako le (4) hobaneng ha AN e le teng ka mefuta e 'meli: fat-phobic AN and non-fat-phobic AN. Mosebetsi oa nakong e tlang oa boiphetetso o etelletsoeng pele ke mohlala ona o lebelletsoe ho nts'etsapele kutloisiso e atileng ea biopsychosocial ea mathata a ho ja.

Sengoloa sena sa tlhahlobo se fana ka maikutlo a hore phapang lipakeng tsa mathata a ho ja e kanna ea aroloa ke ho fapana le ho ts'oaroa ha maikutlo ka khatello ea maikutlo le neuroinfrance e bakoang ke khatello ea maikutlo e sa foleng. Ha tekanyo ea khatello ea maikutlo le (kamora nako) karabelo ea khatello ea maikutlo le ho feto-fetoha ha maikutlo, mofuta o bolela esale pele hore matšoao a mokuli le bokuli ba bokuli bo jang bo fetoha ka ho loketseng (Setšoantšo sa 2). Bopaki boo re bo hlahlobileng bo fana ka maikutlo a hore phapang pakeng tsa BN le phenotypes e hlaha ho tloha tekanyo ea neuroinfrance e bakoang ke khatello ea maikutlo e sa foleng, ho bakuli ba AN ba nang le neuroinflammation e matla ho feta bakuli ba BN. Kahoo, boemo ba mokuli bothateng ba ho ja bo tsoela pele (Setšoantšo sa 2) e lemohuoa ke karabelo ea bona ea khatello ea maikutlo le neuroinfigueation, tseo ka bobeli li susumetsoang ke khatello ea maikutlo le khatello ea maikutlo.

Ka lebaka la bopaki bo hlahlojoang sengoling sena, ho ka utloahala hore neuroinfigueation e boloka boteng ba ho theola boima ba bakuli ba nang le mathata a ho ja, ba phahame haholo ho bakuli ba BED le ba tlase haholo. Bakuli ba BED ha ba itlhatsoe, ho fana ka maikutlo a hore mmele o fokola haholo ho fokotsa boima ba 'mele ho feta ho bakuli ba BN. Tabatabelo ena e kopantsoe ke maikutlo a atileng a kelello mabapi le lijo, boima ba 'mele, lijo, boikoetliso le ponahalo, le boits'oaro bo kang ba OCD bo reretsoeng ho sebetsana le litaba tsena. Re kholoa hore le neininfuru e matla ho bakuli ba AN, le matla a bona a ho fokotsa boima ba 'mele le ho tšaba ho nona, hape ba phehellang le ho feteletseng ke litloaelo tsa bona tse kang OCD (Setšoantšo sa 1). Bopaki bo bong ba semelo sa rona bo fanoa ke liphetho mabapi le katleho ea olanzapine (Dold et al., 2015; Himmerich et al., 2017) le zinki e le kalafo bakeng sa AN (Safai-Kutti le Kutti, 1986; Safai-Kutti, 1990; Birmingham et al., 1994; Birmingham le Gritzner, 2006). Ntle le moo, ka bobeli ba tsejoa ba na le thepa e khahlanong le ho ruruha. Patlisiso ea nako e tlang e ka etsoa mabapi le katleho ea moemeli e mong oa anti-inflammatory, minocycline, joalo ka khetho ea kalafo bakeng sa AN le BN (cf. Esalatmanesh et al., 2016).

Kaha bopaki bo fetolang (leha e le bo sa tobang) bo bontša hore bakuli ba nang le anorexia nervosa ba na le neuroinflammation, lithuto tsa positron emission tomography scanning (PET) li hlokahala ho fana ka ts'ehetso e eketsehileng bakeng sa hypothesis ea hore neuroinflammation ke mokhoa oa tlhaho o hlahisang pherekano ea mathata a ho ja. Ntle le moo, lithuto tsa ho latela moo litekanyo tsa lihormone tsa khatello ea maikutlo, karabelo ea khatello ea maikutlo, litekanyetso tsa serotonin, neuroinfigueation le sebopeho sa gut microbiota li lekantsoeng ho tsoa ho bakuli tseleng tsa bothata ba ho ja li ka senola hore na matšoao a tla fetoha ho latela likhakanyo tse hlahang mohlaleng. Qetellong, re ts'epa hore mohlala oa phetoho ea psychoneuroimmunological e hlahisitsoeng mona o tla khothaletsa ts'ebetso e eketsehileng ea matla, e fane ka ntlafatso e matla litabeng tsa kalafo ea kalafo le lithethefatsi bakeng sa mathata a ho ja 'me qetellong e bonts'e ts'ebeliso ea eona e sebetsang bakeng sa limilione tsa batho ba etellang pele bophelo bo fokolisitsoeng haholo ke mathata a ho ja.

Menehelo ea Mongoli

MR o qopile mongolo. MR e hlalositse mohlala oa psychoneuroimmunological. SL e nkile khopolo-taba ea mismatch hypothesis. SL, TK, le IK e ile ea hlahlobisisa ka nepo taba e ngotsoeng bakeng sa litaba tsa mahlale. MR le SL ba hlophisitse lipalo. Bangoli bohle ba kentse letsoho ho tšehetsa phetoho ea ho qetela ea buka e ngotsoeng ka letsoho le ho e amohela.

dithuso tsa ditjhelete

SL e tšehelitsoe ke chelete ea thuso ea Emil Aaltonen Foundation (bakeng sa lipatlisiso tsa SL Ph.D.). IK e tšehelitsoe ke Lekhotla la Lipatlisiso la Seestonia (PUT-1223) le Lekhotla la Mahlale la Latvia (lzp-2018 / 1-0393). TK e tšehelitsoe ke Lekhotla la Mahlale la Latvia (lzp-2018 / 2-0057). Mehloli ea chelete e ne e se na tšusumetso ho ngotsoeng ha buka e ngotsoeng ka letsoho.

Khohlano ea Thahasello

Bangoli ba bolela hore lipatlisiso li ne li etsoa ka ho se be le likamano leha e le life tsa khoebo kapa tsa lichelete tse ka nkoang e le khohlano e ka 'nang ea e-ba le thahasello.

References