肌肉上瘾
肌肉上瘾[1][2] (英语:muscle dysmorphia),又称恐瘦症[3](英语:bigorexia或megarexia)或逆向厌食症(英语:reverse anorexia),是强迫性精神障碍躯体畸形障碍的一个亚型,通常也同属进食障碍[4][5]。肌肉上瘾症患者总是不合理地认为自己的身材过于瘦小或肌肉不够发达,尽管在大多数情况下该患者的体格实属正常,甚至已经非常健壮[4][6]。
肌肉上瘾症患者以男性为主,特别是那些能以体型或体重取胜的运动项目参与者,这些运动会迫使他们设法增加肌肉或变得更结实[6]。为了达到自己心目中的理想体格,他们会在健身计划、饮食方案及营养补充等方面投注大量时间和心力,其中同化类固醇使用者不在少数[4][6],往往也会关注肌肉以外的躯体变形(如五官、发量或发际线、生殖器大小等)[4][7]。
虽然肌肉上瘾常被类比为神经性厌食症[5][8],但前者比后者更难以识别。除了大众认知有限以外,大部分肌肉上瘾者看起来体态健康也是原因之一[6]。患者的痛苦可能会反应在缺课、旷工和社交孤立上[4][9]。与其他身体变形障碍相比,肌肉上瘾症患者的自杀倾向比率特别高[4]。研究人员认为肌肉上瘾发病率上升有一部分与近期[何时?]对壮硕男体的文化关注度有关[6][10]。
体征与症状
[编辑]尽管对体型不满的现象最早可在6岁男童身上观察到,但一般而言肌肉上瘾症发病于18至20岁之间[11][12]。根据DSM-5躯体变形障碍诊断标准,肌肉上瘾症是透过访察对象是否有“身体太瘦弱或肌肉不够发达的想法”来确诊的。诊疗对象通常还会同时专注于其他身体部位,而前述诊断标准在这种情况下依然成立[13]。
其他已确立的临床特征包括为了增加肌肉而付出过多努力,如限制饮食、过度锻炼、注射促进生长的药物等[14]。经历肌肉上瘾的人每天可花费超过三个小时来思考如何增肌,也无法克制自己持续举重的行为[11]。就像神经性厌食症一样,肌肉上瘾者难以放弃对体型的无止尽追求[15]。患有这种疾病的人会密切监视身材,并且可能会叠穿多件衣服让自己看起来更魁梧[11]。
肌肉上瘾者在他人观察自己的身体时感到极其困扰[14]。病患的职业技能与社会功能受损,这些能力也可能与饮食习惯相互影响[11]。他们会远离那些可能暴露自己体型的活动、人物和场所[11],近半数患者几乎或完全无法察觉到他们的认知有多么不切实际[11][16]。病患也有更高的机率诊断出其他精神障碍,包括饮食失调、情绪障碍、焦虑症、物质使用障碍[16][17][18]以及自杀倾向[11]。
危险因子
[编辑]虽然肌肉上瘾症的发展机制尚未明确,但有几个危险因子已经确认。
心理创伤与霸凌
[编辑]肌肉上瘾者比起一般人群更有可能亲历或目睹性侵犯或家庭暴力之类的创伤性事件[11][19],或因为实际或主观认定的缺陷(如身材矮小、体弱、不擅长体育运动或智力低下等)而在青少年时期遭受霸凌和嘲弄[11][20]。增加体重可以让他们看上去“不好欺负”[11][21]。
社会心理特征
[编辑]与肌肉上瘾症相关的特征包括低自尊以及对于自身体型的高度不满[22]。强壮的体格或发达的肌肉似乎能巩固患者的阳刚气质认同[11]。
媒体接触
[编辑]随著西方媒体越来越强调外貌吸引力,利用男性身体意象制造不安全感的行销活动渐兴[23][24][25][26]。过去20年里,健身杂志和广告中赤膊肌肉男的曝光量有所增加[21][22]。这催使男性受众开始比较并顺合媒体中展示的男性体态[22],在比较自身体型与所追求体型时落差感受随之扩大[27]。在追求发达肌肉的男大学生中,“认同媒体中描绘的理想男体”是重要预测指标之一[28][29]。
参与体育运动
[编辑]有些可能导致肌肉上瘾的心理因素在运动员间同样存在,其中包括强烈竞争心态、控制欲和完美主义等[22],而且运动员往往对自己的体型和体重更加挑剔[30]。运动表现不达标的运动员可能会转而致力于改变体型,这一点与肌肉上瘾的症状重叠[6]。体型、力量或体重可以在某些运动中形成竞争优势(如健美、拳击、摔跤等),而参加这些运动与肌肉上瘾相关[14][23][31]。相对而言,有肌肉上瘾倾向的人也更有可能参与此类运动[6]。
治疗
[编辑]肌肉上瘾患者可能无法意识到自己的追求和关注是无理且失调的,或因为讳疾忌医而导致治疗受阻[6]。治疗肌肉上瘾的科学研究有限,大多来自病例报告和轶事证据[11],没有具体的方案得以验证[6]。尽管如此,有证据支持家庭辅导、认知行为治疗和选择性5-羟色胺再摄取抑制剂等方案的疗效[11]。此外,未经治疗的患者预后情况同样缺乏研究[11]。
患病率
[编辑]肌肉上瘾症的患病率差异悬殊,研究样本中男性的患病率从1%到54%不等[11]。健身房会员、举重和健美运动员群体的患病率要高于普通人群[11],同化类固醇使用者中的比例更高[19][32]。这种疾病在女性群体中虽然少见但时有发生,特别是经历过性侵犯的女性健美运动员[11][19]。中国、南非和拉丁美洲等不同文化区域也都有患病记载[18][33][34][35][36]。较少接触西方媒体的人群患上肌肉上瘾症的机率较低[37]。
历史
[编辑]肌肉上瘾的概念在1990年代后期首次由医疗人员提出[11][38][39]。2016年有50%经过同行评审的文章都是过去五年里发表的[11]。
尽管肌肉上瘾最初被视为神经性厌食症的反面——追求身材壮硕而非纤瘦[38] ——但后来研究人员出于主观体验将其与躯体变形障碍相匹配[14]。(仍有争论)
美国精神病学协会在2013年发布的第五版《精神疾病诊断和统计手册》中将肌肉上瘾症归类为躯体变形障碍[13]。1992年出版的国际疾病和相关健康问题统计分类第10版中没有肌肉上瘾症[32]。
重新分类
[编辑]肌肉上瘾症的分类常引发争论,也有归入其他分类的提案。
- 饮食失调:肌肉上瘾症的许多特征与饮食失调重叠[11][40][41],例如关注体重和体型的改变[42],而躯体变形障碍通常缺乏这类有关饮食和运动的细则[41]。此外,肌肉上瘾者往往在饮食态度测试和饮食失调量表中得分较高[36][43],也和神经性厌食症患者共享诊断交叉[44]。肌肉上瘾与饮食失调之间的相关性比与躯体变形障碍的相关性要高[17][45]。治疗饮食失调的方法也可能对肌肉上瘾有效[46]。
- 行为成瘾:一些研究人员认为肌肉上瘾应归类于行为成瘾[11][41][42][45]。肌肉上瘾者通过运动、饮食、购买相关产品等活动来维持身体意象的行为很容易招致人际冲突[45],而强迫性肌肉锻炼和严格的饮食管控也会加剧这些冲突[45]。再者,患者戒绝此类活动时常会诱发戒断症状,驱使他们重复强迫行为[40][45]。
参考文献
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