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使用者:NozomuAyaz/肌肉上癮

維基百科,自由的百科全書

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),是強迫性精神障礙軀體畸形障礙的一個亞型,通常也同屬進食障礙[4][5]。肌肉上癮症患者總是不合理地認為自己的身材過於瘦小或肌肉不夠發達,儘管在大多數情況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變得更結實[6]。為了達到自己心目中的理想體格,他們會在健身計劃、飲食方案及營養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經性厭食症[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]。患者的痛苦可能會反應在缺課、曠工和社交孤立[4][9]。與其他身體變形障礙相比,肌肉上癮症患者的自殺傾向比率特別高[4]。研究人員認為肌肉上癮發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

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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發病於18至20歲之間[11][12]。根據DSM-5軀體變形障礙診斷標準,肌肉上癮症是透過訪察對象是否有「身體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專注於其他身體部位,而前述診斷標準在這種情況下依然成立[13]

其他已確立的臨床特徵包括為了增加肌肉而付出過多努力,如限制飲食、過度鍛鍊、注射促進生長的藥物等[14]。經歷肌肉上癮的人每天可花費超過三個小時來思考如何增肌,也無法克制自己持續舉重的行為[11]。就像神經性厭食症一樣,肌肉上癮者難以放棄對體型的無止盡追求[15]。患有這種疾病的人會密切監視身材,並且可能會疊穿多件衣服讓自己看起來更魁梧[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]。病患的職業技能與社會功能受損,這些能力也可能與飲食習慣相互影響[11]。他們會遠離那些可能暴露自己體型的活動、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實際[11][16]。病患也有更高的機率診斷出其他精神障礙,包括飲食失調、情緒障礙焦慮症物質使用障礙[16][17][18]以及自殺傾向[11]

危險因子

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雖然肌肉上癮症的發展機制尚未明確,但有幾個危險因子已經確認。

心理創傷與霸凌

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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創傷性事件[11][19],或因為實際或主觀認定的缺陷(如身材矮小、體弱、不擅長體育運動或智力低下等)而在青少年時期遭受霸凌和嘲弄[11][20]。增加體重可以讓他們看上去「不好欺負」[11][21]

社會心理特徵

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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滿[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]

媒體接觸

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隨著西方媒體越來越強調外貌吸引力,利用男性身體形象製造不安全感的行銷活動漸興[23][24][25][26]。過去20年裡,健身雜誌和廣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,「認同媒體中描繪的理想男體」是重要預測指標之一[28][29]

參與體育運動

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有些可能導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、控制慾和完美主義[22],而且運動員往往對自己的體型和體重更加挑剔[30]。運動表現不達標的運動員可能會轉而致力於改變體型,這一點與肌肉上癮的症狀重疊[6]。體型、力量或體重可以在某些運動中形成競爭優勢(如健美拳擊摔跤等),而參加這些運動與肌肉上癮相關[23][14][31]。相對而言,有肌肉上癮傾向的人也更有可能參與此類運動[6]

治療

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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,大多來自病例報告和軼事證據[11],沒有具體的方案得以驗證[6]。儘管如此,有證據支持家庭輔導認知行為治療選擇性5-羥色胺再攝取抑制劑等方案的療效[11]。此外,未經治療的患者預後情況同樣缺乏研究[11]

患病率

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肌肉上癮症的患病率差異懸殊,研究樣本中男性的患病率從 1% 到 54% 不等[11]健身房會員、舉重和健美運動員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見但時有發生,特別是經歷過性侵犯的女性健美運動員[11][19]中國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]。較少接觸西方媒體的人群患上肌肉上癮症的機率較低[37]

歷史

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肌肉上癮的概念在1990年代後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發表的[11]

儘管肌肉上癮最初被視為神經性厭食症的反面——追求身材壯碩而非纖瘦[38] ——但後來研究人員出於主觀體驗將其與軀體變形障礙相匹配[14]。(仍有爭論)

美國精神病學協會在2013年發布的第五版《精神疾病診斷和統計手冊》中將肌肉上癮症歸類為軀體變形障礙[13]。1992年出版的國際疾病和相關健康問題統計分類10版中沒有肌肉上癮症[32]

重新分類

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肌肉上癮症的分類常引發爭論,也有歸入其他分類的提案。

  • 飲食失調:肌肉上癮症的許多特徵與飲食失調重疊[11][39][40],例如關注體重和體型的改變[41],而軀體變形障礙通常缺乏這類有關飲食和運動的細則[40]。此外,肌肉上癮者往往在飲食態度測試和飲食失調量表中得分較高[42][36],也和神經性厭食症患者共享診斷交叉[43]。肌肉上癮與飲食失調之間的相關性比與軀體變形障礙的相關性要高[17][44]。治療飲食失調的方法也可能對肌肉上癮有效[45]
  • 行為成癮:一些研究人員認為肌肉上癮應歸類於行為成癮[11][40][44][41]。肌肉上癮者通過運動、飲食和購買相關產品等活動來維持身體意象的行為很容易招致人際衝突[44],而強迫性肌肉鍛鍊和嚴格管控飲食也會加劇這些衝突[44]。再者,戒絕此類活動時常會誘發戒斷症狀,促使患者重複強迫行為[39][44]

參考文獻

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  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. ^ 黃敏. 狂迷健美?警惕恐瘦症-新华网. 新華網. 2015-09-23 [2022-03-27]. 
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