مطالعهٔ كيفي عوامل روان‌ شناختي در اختلال پرخوري زنان

Psychological Factors in Women With Binge Eating Disorder: A Qualitative Study

زمينه و هدف: اختلال پرخوري يكي از اختلالات روان‌شناختي است كه به‌دليل مؤثربودن بر جنبه‌هاي مختلف زندگي و ارتباط با ساير مشكلات جسمي و روان‌شناختي، به‌ويژه در جامعهٔ زنان بسيار به آن توجه شده است؛ بنابراين پژوهش حاضر با هدف مطالعهٔ ماهيت اختلال پرخوري در زنان و شناسايي عوامل روان‌شناختي مؤثر در آن انجام شد. روش‌بررسي: مطالعه با روش كيفي داده‌بنياد انجام شد. جامعهٔ مشاركت‌كنندگان، زنان مبتلا به اختلال پرخوري بودند كه به كلينيك تخصصي تغذيهٔ دانشكدهٔ شهيد بهشتي شهر تهران در سال 1398 مراجعه كردند. نمونه‌گيري براساس نمونه‌گيري نظري انجام پذيرفت. در اين پژوهش در كل با 15 داوطلب واجد شرايط مصاحبه شد. مصاحبه‌ها ضبط و سپس رونويسي شد. تجزيه‌وتحليل داده‌ها هم‌زمان با جمع‌آوري آن‌ها به‌روش تحليل مقايسه‌اي مداوم استراوس و كوربين (1998) صورت گرفت. براي اطمينان از صحت و اعتبار پژوهش از معيارهاي معتبر گوبا و لينكلن (2000) استفاده شد. يافته‌ها: از 29 كد به‌دست‌آمده در كدگذاري باز، هشت مقولۀ علل هيجاني منفي فردي، علل هيجاني منفي بين‌فردي، رفتارهاي اجتنابي-اجباري افراطي، عادات خوردن نامناسب، زمان نامناسب خوردن، كسب هيجان مثبت، علل فقدان هيجان فردي و علل فقدان هيجان بين‌فردي در كدگذاري محوري، استخراج شد. از آن‌ها نيز سه عامل اصلي علل هيجاني منفي، عادات رفتاري نامناسب و فقدان هيجان، انتخاب و استخراج شد كه هريك دربرگيرندهٔ زيرمقوله‌هايي در دو حوزهٔ فردي و بين‌فردي بود. نتيجه‌گيري: نتايج نشان داد كه عوامل روان‌شناختي مؤثر در اختلال پرخوري در زنان شامل عوامل اصلي هيجان منفي، عادت‌هاي رفتاري نامناسب و فقدان هيجان است. يافته‌هاي اين پژوهش مي‌تواند در تدوين مدل‌هاي درماني مؤثر در اختلال پرخوري مدنظر قرار گيرد.

Background & Objectives: Binge Eating Disorder (BED) is among the most prevalent eating conditions in individuals. BED is the periodic and uncontrolled consumption of large amounts of food in a short period, followed by guilt, depression, or self–loathing. Individuals with BED also experience various psychological issues, including depression and anxiety. Recently, this disorder has become widespread in females. Women with BED are often dissatisfied with their body weight and shape; they experience body–based social anxiety, i.e., associated with a concern about weight and eating that plays an important role in predicting eating disorders. The present study aimed to investigate the nature of BED in women and identify its associated psychological factors. Methods: This study was conducted using the qualitative research method of grounded theory. The statistical population consisted of women with BED who referred to the Specialty Nutrition Clinic of Shahid Beheshti University of Tehran City, Iran, in 2019. The inclusion criteria of the study included having 25 to 50 years of age; no acute physical or mental illness; no pregnancy or lactation; no weight loss diet, no type 2 diabetes, and no substance abuse. The necessary conditions and the absence of physical illness were confirmed by a general practitioner and related tests. Besides, the absence of acute mental disorders was assessed by diagnostic interviews by researchers. The study participants were selected by purposive sampling method in which the information was collected in the research field and analyzed outside; the researcher returned to the research field to collect further data. This zigzag process continued until the data categories were saturated. In total, 15 eligible volunteers were interviewed. Interviews were recorded and transcribed subsequently. The interviews were semi–structured and covered general questions, such as "in what conditions do you often overeat?", "how do you usually overeat?", and "how do you feel about your body appearance?". When necessary and for obtaining more details, exploratory questions, such as "can you explain more about this?" or "can you make your point clearer?" were probed. Each interview lasted 45–60 minutes. The collected data were analyzed using Straus and Corbin’s continuous comparative analysis (1998). The conceptualization (open coding) was first performed in the analysis and axial coding was implemented to refine and differentiate the obtained categories (closest to the same meaning); finally, selective coding or the process of integrating categories into a template was performed. The validity and reliability of the research were assessed per Guba and Lincoln criteria (2000). The acceptance of the data was established by reviewing the manuscripts by the study participants, which led to a better understanding of their experiences by the researcher and increased the participants' confidence. Verifiability was verified by reviewing the text of the interviews, as well as agreement on the codes and classes extracted by the relevant experts and authors. Furthermore, the consistency of the findings was determined using the opinion of experts and re–reading the data. Transferability also enabled the better presentation of data and factors through interviews with different research participants. Results: The study participants included 15 women with BED with an age range of 35 to 48 years, with degrees ranging from diploma to doctorate. From the 29 codes obtained in open coding, 8 categories of axial coding were extracted, including individual negative emotional causes; interpersonal negative emotional causes; extreme avoidance–compulsive behaviors; improper eating habits; inappropriate eating time; acquiring positive emotion, and causes of the lack of individual and interpersonal emotional aspects. Next, three factors, including negative emotion causes, inappropriate behavioral habits, and the lack of emotion were selected and extracted. Each component contained a specific sub– component in individual and interpersonal domains. Accordingly, all three factors fell in the personal domain and two negative emotional factors and the lack of emotion were also classified in the interpersonal domain. Conclusion: The present research results suggested that the psychological factors of BED in women included (the main factors of) negative emotion, the lack of emotion, and inappropriate behavioral habits, i.e., correlated with each other. These characteristics were classified in the context of individual and interpersonal aspects. In addition to the impact of individual factors, interpersonal characteristics are essential and should be considered as systemic factors. The collected data can be used in developing different approaches for the treatment of BED.