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User:NozomuAyaz/肌肉上癮

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肌肉上癮[1][2] (英語:Muscle dysmorphia),又稱「恐瘦症」[3](英語:bigorexia/megarexia)或「逆向厭食症」(英語: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]。肌肉上癮症患者總是不合理地认为自己的身材過於瘦小或肌肉不夠發達,儘管在大多数情况下該患者的體格實屬正常,甚至已經非常健壯[4][6]

肌肉上癮症患者以男性為主,特別是那些能以體型或體重取勝的運動項目參與者,這些運動會迫使他們設法增加肌肉或变得更結實[6]。為了達到自己心目中的理想體格,他們會在健身計劃、饮食方案及营养補充等方面投注大量時間和心力,其中同化類固醇使用者不在少數[4][6],往往也會關注肌肉以外的軀體變形(如五官、髮量或髮際線、生殖器大小等)[4][7]

雖然肌肉上癮常被類比為神经性厌食症[5][8],但前者比後者更難以識別。除了大眾認知有限以外,大部分肌肉上癮者看起來體態健康也是原因之一[6]。患者的痛苦可能会反應在缺課、曠工和社交孤立[4][9]。与其他身体變形障碍相比,肌肉上癮症患者的自杀傾向比率特别高[4]。研究人员認為肌肉上癮发病率上升有一部分與近期對壯碩男體的文化關注度有關[6][10]

體徵與症狀

儘管對體型不滿的現象最早可在6歲男童身上觀察到,但一般而言肌肉上癮症发病於18至20岁之間[11][12]。根据DSM-5軀體變形障礙诊断标准,肌肉上癮症是透過訪察對象是否有「身体太瘦弱或肌肉不夠發達的想法」來確診的。診療對象通常還會同時专注于其他身体部位,而前述診斷標準在這種情況下依然成立[13]

其他已確立的临床特征包括為了增加肌肉而付出過多努力,如限制饮食、过度锻炼、注射促进生长的药物等[14]。经历肌肉上癮的人每天可花费超过三个小时来思考如何增肌,也无法克制自己持續举重的行為[11]。就像神经性厌食症一樣,肌肉上癮者難以放棄對體型的無止盡追求[15]。患有这种疾病的人会密切监视身材,並且可能会疊穿多件衣服讓自己看起来更魁梧[11]

肌肉上癮者在他人觀察自己的身體時感覺到極其困擾[14]。病患的职业技能與社会功能受損,這些能力也可能與饮食习惯相互影響[11]。他們会遠離那些可能暴露自己体型的活动、人物和場所[11],近半數患者幾乎或完全無法察覺到他們的認知有多麼不切实际[11][16]。病患也有更高的機率診斷出其他精神障碍,包括饮食失调、情绪障碍焦虑症物质使用障碍[16][17][18]以及自杀傾向[11]

危險因子

虽然肌肉上癮症的發展機制尚未明確,但有几个危险因子已經確認。

心理創傷與霸凌

肌肉上癮者比起一般人群更有可能親歷或目睹性侵犯家庭暴力之類的创伤性事件[11][19],或因為实际或主觀認定的缺陷(如身材矮小、體弱、不擅長體育运动或智力低下等)而在青少年時期遭受霸凌和嘲弄[11][20]。增加体重可以讓他們看上去「不好欺負」[11][21]

社会心理特征

與肌肉上癮症相關的特徵包括低自尊以及對於自身體型的高度不满[22]。強壯的體格或發達的肌肉似乎能鞏固患者的陽剛氣質認同[11]

媒体接觸

隨著西方媒体越來越強調外貌吸引力,利用男性身体形象製造不安全感的行銷活動漸興[23][24][25][26]。过去20年裡,健身杂志和广告中赤膊肌肉男的曝光量有所增加[21][22]。這催使男性受眾開始比較並順合媒體中展示的男性體態[22],在比較自身體型與所追求體型時落差感受隨之擴大[27]。在追求肌肉發達的男大學生中,「認同媒体中描绘的理想男體」是重要預測指標之一[28][29]

參與體育運動

有些可能导致肌肉上癮的心理因素在運動員間同樣存在,其中包括強烈競爭心態、控制慾和完美主义[22],而且运动员往往对自己的體型和体重更加挑剔[30]。运动表现不達標的运动员可能会轉而致力於改變体型,這一點与肌肉上癮的症狀重叠[6]。体型、力量或体重可以在某些運動中形成竞争优势(如健美拳擊摔跤等),而參加這些運動与肌肉上癮相关[23][14][31]。相對而言,有肌肉上癮傾向的人也更有可能參與此类运动[6]

治疗

肌肉上癮患者可能無法意識到自己的追求和關注是無理且失調的,或因為諱疾忌醫而導致治療受阻[6]。治療肌肉上癮的科學研究有限,大多來自病例报告和轶事證據[11],没有具体的方案得以验证[6]。尽管如此,有证据支持家庭輔導认知行为治疗选择性5-羟色胺再摄取抑制剂等方案的疗效[11]。此外,未經治疗的患者预后情況同樣缺乏研究[11]

患病率

肌肉上癮症的患病率差异懸殊,研究样本中男性的患病率从 1% 到 54% 不等[11]健身房會員、举重和健美运动员群體的患病率要高於普通人群[11],同化類固醇使用者中的比例更高[19][32]。這種疾病在女性群體中雖然少见但時有發生,特別是经历过性侵犯的女性健美运动员[11][19]中国南非拉丁美洲等不同文化區域也都有患病記載[18][33][34][35][36]。较少接触西方媒体的人群患上肌肉上癮症的機率較低[37]

历史

肌肉上癮的概念在1990年代后期由醫療人員首次提出[38][14][11]。2016年有50%經過同行評審的文章都是過去五年裡发表的[11]

尽管肌肉上癮最初被视为神经性厌食症的反面——追求身材壯碩而非纖瘦[38] ——但后来研究人员出於主观体验將其与軀體變形障礙相匹配[14]。(仍有爭論)

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》中將肌肉上癮症归类为軀體變形障碍[13]。1992年出版的国际疾病和相关健康问题统计分类10版中没有肌肉上癮症[32]

重新分类

肌肉上癮症的分類常引發爭論,也有歸入其他分类的提案。

  • 饮食失调:肌肉上癮症的许多特征与饮食失调重叠[11][39][40],例如关注体重和体型的改变[41],而軀體變形障礙通常缺乏這類有關饮食和运动的細則[40]。此外,肌肉上癮者往往在饮食态度测试和饮食失调量表中得分较高[42][36],也和神经性厌食症患者共享诊断交叉[43]。肌肉上癮與饮食失调之间的相关性比與軀體變形障碍的相關性要高[17][44]。治療饮食失调的方法也可能对肌肉上癮有效[45]
  • 行为成瘾:一些研究人员認為肌肉上癮應歸類於行为成瘾[11][40][44][41]。肌肉上癮者通过运动、饮食和購買相關產品等活動來维持身體意象的行為很容易招致人際衝突[44],而强迫性肌肉鍛鍊和嚴格管控饮食也会加剧这些冲突[44]。再者,戒絕此類活動時常會誘發戒断症状,促使患者重複強迫行為[39][44]

參考文獻

  1. ^ 張志成. 猛男情結、體型知覺、肌肉上癮與運動依賴之關聯 (47:1): 391–406. 2014 [2022-03-27]. 
  2. ^ 張志成; 王俊明. 男性重量訓練者的肌肉發達驅力及肌肉上癮. 國家圖書館. 大專體育學刊. 2013 [2022-03-27]. 
  3. ^ 黄敏. 狂迷健美?警惕恐瘦症-新华网. 新华网. 2015-09-23 [2022-03-27]. 
  4. ^ 4.0 4.1 4.2 4.3 4.4 4.5 Katharine A Phillips, Understanding Body Dysmorphic Disorder: An Essential Guide (New York: Oxford University Press, 2009), pp 50–51.
  5. ^ 5.0 5.1 Lee F Monaghan & Michael Atkinson, Challenging Myths of Masculinity: Understanding Physical Cultures (Surrey: Ashgate, 2014), p 86.
  6. ^ 6.0 6.1 6.2 6.3 6.4 6.5 6.6 6.7 6.8 James E Leone, Edward J Sedory & Kimberly A Gray, "Recognition and treatment of muscle dysmorphia and related body image disorders", Journal of Athletic Training, 2005 Oct–Dec;40(4):352–359.
  7. ^ Iqbal Ahmed. Body Dysmorphic Disorder: Practice Essentials, Background, Pathophysiology. eMedicine. 2019-10-03 [2022-03-28]. 
  8. ^ Anthony J Cortese, Provocateur: Images of Women and Minorities in Advertising, 4th edn (London: Rowman & Littlefield, 2016), p 94.
  9. ^ Anonymous webpage author, "Muscle dysmorphia", McCallum Place website, visited 21 May 2016.
  10. ^ Harrison G Pope Jr, Katharine A Phillips & Roberto Olivardia, The Adonis Complex: The Secret Crisis of Male Body Obsession (New York: Free Press, 2000) pp 156, 160,197.
  11. ^ 11.00 11.01 11.02 11.03 11.04 11.05 11.06 11.07 11.08 11.09 11.10 11.11 11.12 11.13 11.14 11.15 11.16 11.17 11.18 11.19 11.20 Tod D, Edwards C & Cranswick I (2016), "Muscle dysmorphia: Current insights", Psychology Research and Behavior Management 9:179–188.
  12. ^ McCabe MP & Ricciardelli LA (2004), "Body image dissatisfaction among males across the lifespan: A review of past literature", Journal of Psychosomatic Research 56(6):675–685.
  13. ^ 13.0 13.1 American Psychiatric Association, "Body dysmorphic disorder", Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (Arlington, VA: American Psychiatric Association, 2013).
  14. ^ 14.0 14.1 14.2 14.3 14.4 Pope HG Jr, Gruber AJ, Choi P, Olivardia R & Phillips KA (1997), "Muscle dysmorphia: An underrecognized form of body dysmorphic disorder", Psychosomatics: Journal of Consultation and Liaison Psychiatry 38(6):548–557.
  15. ^ Mosley PE. Bigorexia: Bodybuilding and muscle dysmorphia. European Eating Disorders Review. 2009, 17 (3): 191–198. ISSN 1099-0968. PMID 18759381. doi:10.1002/erv.897 (英语). 
  16. ^ 16.0 16.1 Cafri G, Olivardia R & Thompson JK (2008), "Symptom characteristics and psychiatric comorbidity among males with muscle dysmorphia", Comprehensive Psychiatry 49(4):374–379.
  17. ^ 17.0 17.1 Pope CG, Pope HG, Menard W, Fay C, Olivardia R, & Phillips KA (2005), "Clinical features of muscle dysmorphia among males with body dysmorphic disorder: Body Image 2(4):395–400.
  18. ^ 18.0 18.1 Hitzeroth V, Wessels C, Zungu-Dirwayi N, Oosthuizen P, & Stein DJ (2001), "Muscle dysmorphia: A South African sample", Psychiatry and Clinical Neurosciences 55(5):521–523.
  19. ^ 19.0 19.1 19.2 Gruber AJ & Pope HG (1999), "Compulsive weight lifting and anabolic drug abuse among women rape victims", Comprehensive Psychiatry 40(4):273–277.
  20. ^ Edwards C, Molnar G & Tod D (2017), "Searching for masculine capital: Experiences leading to high drive for muscularity in men", Psychology of Men & Masculinity 18(4)"361–371.'
  21. ^ 21.0 21.1 Olivardia R (2001), "Mirror, mirror on the wall, who's the largest of them all? the features and phenomenology of muscle dysmorphia", Harvard Review of Psychiatry 9(5):254–259.
  22. ^ 22.0 22.1 22.2 22.3 Grieve FG (2007), "A conceptual model of factors contributing to the development of muscle dysmorphia", Eating Disorders: The Journal of Treatment & Prevention 15(1):63–80.
  23. ^ 23.0 23.1 Cohane GH, & Pope HG Jr (2001), "Body image in boys: A review of the literature", International Journal of Eating Disorders 29(4):373–379.
  24. ^ Mangweth B, Pope HGJ, Kemmler G, Ebenbichler C, Hausmann A, et al. (2001), "Body image and psychopathology in male bodybuilders", Psychotherapy and Psychosomatics 70(1):38–43.
  25. ^ Pope HG Jr, Olivardia R, Borowiecki JJ 3rd & Cohane GH (2001), "The growing commercial value of the male body: A longitudinal survey of advertising in women's magazines", Psychotherapy and Psychosomatics 70(4):189–192.
  26. ^ Leit RA, Pope HG Jr, & Gray JJ (2001), "Cultural expectations of muscularity in men: The evolution of playgirl centerfolds", International Journal of Eating Disorders 29(1):90–93.
  27. ^ Leit RA, Gray JJ, & Pope HG Jr (2002), "The media's representation of the ideal male body: A cause for muscle dysmorphia?", International Journal of Eating Disorders 31(3):334–338.
  28. ^ Daniel S & Bridges SK (2010)m The drive for muscularity in men: Media influences and objectification theory, Body Image 7(1):32–38.
  29. ^ Parent MC & Moradi B (2011), "His biceps become him: A test of objectification theory's application to drive for muscularity and propensity for steroid use in college men", Journal of Counseling Psychology 58(2):246–256.
  30. ^ Davis C & Cowles M (1991), "Body image and exercise: A study of relationships and comparisons between physically active men and women", Sex Roles 25(1–2):33–44.
  31. ^ Chung B (2001), "Muscle dysmorphia: A critical review of the proposed criteria", Perspect Biol Med 44(4):565–574.
  32. ^ 32.0 32.1 dos Santos Filho CA, Tirico PP, Stefano SC, Touyz SW & Claudino AM (2016), "Systematic review of the diagnostic category muscle dysmorphia", Australian and New Zealand Journal of Psychiatry 50(4):322–333.
  33. ^ Ung EK, Fones CS, & Ang AW (2000), Muscle dysmorphia in a young Chinese male, Annals of the Academy of Medicine (Singapore) 29(1):135–137.
  34. ^ Soler PT, Fernandes HM, Damasceno VO, et al. (2013), "Vigorexy and levels of exercise dependence in gym goers and bodybuilders", Revista Brasileira de Medicina do Esporte 19(5):343–348.
  35. ^ Rutsztein G, Casguet A, Leonardelli E, López P, Macchi M, Marola ME & Redondo G (2004), "Imagen corporal en hombres y su relación con la dismorfia muscular", Revista Argentina De Clínica Psicológica 13(2):119–131.
  36. ^ 36.0 36.1 Behar R & Molinari D (2010), "Muscle dysmorphia, body image and eating behaviors in two male populations", Revista Médica de Chile 138(11):1386–1394.
  37. ^ Yang CJ, Gray P, & Pope HG Jr, (2005), "Male body image in Taiwan versus the west: Yanggang Ahiqi meets the Adonis complex", The American Journal of Psychiatry 162(2):263–269.
  38. ^ 38.0 38.1 Pope HG, Katz DL & Hudson JI (1993), "Anorexia nervosa and 'reverse anorexia' among 108 male bodybuilders", Comprehensive Psychiatry 34(6):406–409.
  39. ^ 39.0 39.1 Griffiths S, Mond JM, Murray SB & Touyz S (2015), "Positive beliefs about anorexia nervosa and muscle dysmorphia are associated with eating disorder symptomatology", Australian and New Zealand Journal of Psychiatry 49(9):812–820.
  40. ^ 40.0 40.1 40.2 Murray SB & Touyz SW (2013), "Muscle dysmorphia: Towards a diagnostic consensus", Australian and New Zealand Journal of Psychiatry 47(3):206–207.
  41. ^ 41.0 41.1 Russell J (2013), Commentary on: "Muscle Dysmorphia: Towards a diagnostic consensus". Australian and New Zealand Journal of Psychiatry 47(3):284–285.
  42. ^ Nieuwoudt JE, Zhou S, Coutts RA & Booker R (2012), "Muscle dysmorphia: Current research and potential classification as a disorder", Psychology of Sport and Exercise 13(5):569–577.
  43. ^ Murray SB, Rieger E, Touyz SW & De la GG (2010), "Muscle dysmorphia and the DSM-V conundrum: Where does it belong? A review paper", International Journal of Eating Disorders 43(6):483–491.
  44. ^ 44.0 44.1 44.2 44.3 44.4 Foster AC, Shorter GW, & Griffiths MD (2015), "Muscle dysmorphia: Could it be classified as an addiction to body image?", J Behav Addict 4(1):1–5.
  45. ^ Greenberg ST & Schoen EG (2008), "Males and eating disorders: Gender-based therapy for eating disorder recovery", Professional Psychology: Research and Practice 39(4):464–471.