行動療法による神経性食欲不振症の治療

抄録

From the behavioral point of view, anorexia nervosa is understood as a manifestation of abnormal eating behavior which began casually and has been continuously reinforced by rewards of attention-getting from close relatives and others and of anxiety-reduction due to the diseased state, etc.Our report is a case of anorexia nervosa who was successfully treated with behavior therapy technique. The patient was a 22-year-old male whose symptoms has persisted for about 4 years. The main therapeutic measures were as follows : I. Exclusion of reinforcing factors of abnormal eating behavior : (1) the patient's daily life was restricted within the hospital ward ; contacts with relatives by means of visits, telephone calls, writing, etc were strictly prohibited ; (2) all medical personnel behaved neutral and unresponsive to the abnormal eating behavior and subjective complaints of the patient.II. Positive procedures for reshaping the desirable eating behavior : (1) the amout of daily diet given to the patient started from 1,100 cal, hoping to motivate the patient's psychological need for food, and was gradually increased by 200-300cal within an interval of 5-7 days ; (2) each time the patient consumed all the food given, he was positively encouraged by verbal praise sand attention from the medical staff ; (3) a weight increase of 0.5kg or more per week was positively rewarded by allowing the patient to make one telephone call, to see a visitor or to leave the ward for a short time.By these procedures, the patient's weight increased from 33kg to 49kg in about 5 months. Follow-up studies after five and a half years showed that he had been happily married and well-adjusted to his job.