Ichashanda kune nhengo yemhuri yangu here?
Mhuri-based treatment (FBT, iyo inonziwo Maudsley nzira) inotungamirira kurapwa kwevechiri kuyaruka zvinetso zvekudya kusanganisira anorexia nervosa , bulimia nervosa , uye kumwe kumwe kududzwa kudyidzana kana chirwere chekudya (OSFED ).
Icho chirongwa chinoshandiswa pamanyoro chinopiwa nevanodzidziswa vakadzidza. Iyo inonyanya kubudiswa mune kunze kwekugadzirisa zvirongwa , kunyange zvazvo kune dzimwe nzvimbo dzekugara uye dzakasarura muzvipatara (PHP) zvirongwa zvinosanganisira FBT.
Kunyange zvazvo FBT isingasviki kumhuri imwe neimwe, kutsvakurudza kunoratidza kuti inoshanda zvikuru uye inokurumidza kuita pane dzimwe dzakawanda mishonga. Saka inofanira kuonekwa seyo nzira yokutanga yekurapa vana, vechidiki, uye vamwe vechidiki.
Bhuku rinobva kuMutambo Wemazuva Rinosvika
FBT inomirira kusimuka kukuru kubva kune dzimwe nzira dzechirwere. Mafungiro ekare nezveanorexia nezvinetso zvekudya, zvakasimudzwa naHilde Bruch nevamwe, vakatsanangura kuti ivo vanoenda kumhuri enmeshment kana zvimwe zvinetso. Amai vaitenda kuti ndiyo inonyanya kukonzera kushungurudzwa kwevana vavo, sezvavakanga vari mune schizophrenia uye autism. Iyo inoratidzira kurapa vabereki vakarayirwa kuti vaende pamba uye vashandura vana vavo neineorexia pamusoro pekurapwa nemunhu mumwe oga kana kugara munzvimbo dzokurapa nzvimbo-nzira yatinoziva iye zvino, kakawanda, inokuvadza mhuri dzose nevarwere.
Tsvakurudzo ichangobva kuitika yakanyora pfungwa yekubata kwevabereki kushungurudzwa kwekudya, sezvazviri kune schizophrenia uye autism. Zvidzidzo zveGenetic zvinoratidza kuti inenge 50 kusvika ku80 muzana yehutano hwemunhu wehutano hwekudya hunokonzerwa nemararamiro. Zvinyorwa izvi zvakadzokorora zvidzidzo zvekushaya nenzara zvichiratidza kuti humwe unhu hunoita seanorexia huri chikonzero chekushaya zvokudya zvinovaka muviri zvinowedzera anorexia .
Zvinotendwawo kuti vanachiremba vakawanda vakaita chisarudzo chekusarudzira chisarudzo: kuona maitiro emhuri sezvavakanga vari kutsvaga kurapwa, vanachiremba vakangoona mhuri dzivharwa muhondo yeupenyu-uye-kufa pamusoro pezvokudya. Kurwisana uku, asi, chiratidzo chechirwere, kwete chikonzero-mumakore anotangira chirwere chekudya, simba ravo rinogona kutarisa kuti rakasiyana nedzimwe mhuri.
Kubvuma kuti uremu hwehupupuriro hwakanga hwachinja, muna 2010, Academy for Eating Disorders yakabudisa pepa repamusoro kunyanya kuramba pfungwa yokuti mhuri zvinhu zvinonyanya kushandiswa pakuvandudza dambudziko rekudya. Ichi chinhu chinoshanduka nokuti chakakonzerwa nekubatanidzwa kukuru kwevabereki mukurapwa mune zvekare uye kugamuchirwa kukuru uye kudiwa kweFBT.
FBT Haisi Yakafanana Semhuri Inorapwa
FBT haifaniri kunge yakavhiringidzika nenzira dzakadaro-dzinodanwa asi dzinogona kunge dzakasiyana-siyana pasi pemumvura yemishonga yemhuri. Chirongwa chemhuri chechizvarwa kazhinji chinotora pfungwa yokuti mwana ane chirwere chekudya ari kuratidza dambudziko remhuri. Inotarisa pakutsanangura nekugadzirisa chinetso ichi kuitira kuporesa chirwere chekudya. Iyi nzira haina kubatsirwa nekutsvakurudza uye inopesana neAED pepa pepa.
Muma1970 nekutanga kwema1980, vanachiremba kuMaudsley Hospital muLondon, England, vakatora mhando dzakasiyana-siyana dzehutano hwemhuri, kubata vabereki sechinhu chakanaka, kwete chekukuvadza. The Maudsley team yakaramba ichikudziridza nekudzidzisa nzira, iyo inowanzotaridzira kwete sematauriro aMuddsley, asi seSystemic family therapy for anorexia nervosa. Parizvino Drs. Dhanieri Le Grange naJames James vakatsanangurwa pamusoro pekutaridzirwa kwebhuku (rakabudiswa muna 2002 uye rakarongedzwa muna 2013), vachinyora mavoti avo ehurukuro Family-Based Treatment (FBT).
Nzira yeFBT yakabatanidzwa mune zvimwe zvehutano hwetsika, rheinhau rerapi, uye chirongwa chemhuri chinogadzirisa.
Kuvhara uye Le Grange vave vakagadzira Dzidzo yeChidiki neAdolescent Eating Disorders, sangano rinodzidzisa vanachiremba mune kurapwa uku uye rine runyorwa rwevashandi vanozivikanwa nevarapi muhudziro.
Mitemo yeFBT
FBT inotora gnostic maonero echirwere chekudya, zvinoreva kuti varapi havaedzi kuongorora kuti nei chirwere chekudya chichigadzirwa. FBT haiti mhosva dzemhuri nekuda kwechirwere . Kusiyana neizvi, inofungidzira hukama hwakasimba pakati pevabereki nemwana uye inopa vabereki kuti vashandise rudo rwavo kubatsira mwana wavo. Vabereki vanoonekwa senyanzvi pamwana wavo, chikamu chinokosha chegadziro, uye nhengo dzeboka rerapa.
Mune FBT, chirwere chekudya chinotaridzirwa sesimba iri kunze iro rine mwana. Vabereki vanokumbirwa kuti vabatane nehutano hwemwana kunopesana nedambudziko rekudya rinotyisidzira kutora mwana wavo kure. Zvokudya zvakakwana zvinotaridzirwa senhanho yekutanga yekugadzirisa; basa revabereki nderekupa chikafu ichi kuburikidza nekushingaira kudya mwana wavo.
Zvirongwa zveFBT zvinowanzobatanidza mhuri yose uye inosanganisira imwe mhuri yekudya muhofisi yechiremba. Izvi zvinopa mushonga mukana wokucherechedza maitiro emhuri dzakasiyana-siyana panguva yekudya uye kudzidzisa vabereki kubatsira mwana wavo kudya. Nokuti varwere vane zvinetso zvekudya vanogona kuuya nekunetseka kwehutano , vanofanira kuongororwa nachiremba panguva yekurapa.
Zvikamu zvitatu zveFBT
FBT ine zvikamu zvitatu:
- Chikamu 1: Kuzara kwevabereki. Vabereki vanowanzotarisira zvakakwana kudya apo ivo vanobatsira mwana wavo kuti adzokerezve mararamiro ezvokudya nguva dzose uye agadzirise zvinetso zvinokanganisa kudya kwepfungwa dzakadai sekuzvidzivirira, kuchenesa, uye kunyanya kuisa muviri. Kana uremu hunoonekwa, chinangwa chiri 1 kusvika 2 pounds pavhiki. Murapi anoshanda kupa simba kuvabereki kutora mabasa aya uye anobatsira vabereki kudzidza kutarisira mwana panguva yezvokudya .
- Chikamu chechipiri: Kudzokorora zvishoma nezvishoma kutonga kune wechidiki. Ichi chikamu chinowanzotanga kamwechete kuyerwa kunowanzodzorerwa, apo kudya kunofamba zviri nani, uye kana maitiro ari pasi pesimba. Kudzora zvishoma nezvishoma kunodzoserwa kumwana wechidiki nenzira yakakodzera-yekare: somuenzaniso, mwana angatanga kuve nezvokudya kana kupedza zvokudya kubva kumubereki. Ikoko kunogona kuva kudzokera shure uye vabereki vanogona kunge vachidzokorora kudzora nguva nenguva kusvikira wechidiki akwana akagadzirira; ichi chikamu chekuita.
- Chikamu 3: Kugadzira rusununguko hwakanaka. Kana mwana wechidiki ari kukwanisa kudya nezera rakakodzera rekuzvimirira uye asingaratidzi kurwara kwemaitiro ekuzvibata, chinangwa chekurapa kushanduka pakuvabatsira kusimbisa hutano hwakanaka uye kubata pane dzimwe nharo dzekusimudzira. Zvimwe zvinetso zvinopesana zvinogona kutariswa. Mhuri inobatsira kuronga zvakare zvakare kuti mwana ane utano.
Kubatsirwa kweFBT
Nzara yebongo inogona kukonzera anosognosia , kusaziva kwekuti munhu anorwara. Somugumisiro, kunogona kuva nguva yakareba yakasakara pamberi pepfungwa dzevechidiki mukudzoka dzinokwanisa kukurudzira kana kunzwisisa kuti varambe vachidzoka. FBT inopa basa rekuchinja maitiro uye kudya kwakakwana kune vabereki uye inovapa unyanzvi uye kudzidzisa kuita zvinangwa izvi. Somugumisiro, inobatsira mwana kuti awanezve kunyange vasati vava nekwanisi yekuzviita ivo pachavo.
Nokuti inowanzoshanda nekukurumidza kupfuura dzimwe kurapwa, FBT inoderedza migumisiro yezvokurapa uye inowedzera mikana yekugadzirisa zvakakwana. Inobvumira mwana kuti arambe ari pamba nevabereki vake uye kazhinji inodhura-inoshanda kudarika kurapwa kwekugara.
Tsvakurudzo paFBT
Kutsvakurudza kwakaratidza kuti vechidiki vanogamuchira FBT vanowanazve pamatunhu akakwirira kupfuura vechidiki vanogamuchira kurapwa kwega:
- Chimwe chidzidzo kubva kuYunivhesiti yeChicago uye kuStanford chinoratidza kuti pamagumo ekwidzi yeFBT, zvikamu zviviri kubva muzvitatu zvevechiri kuyaruka vane anorexia vadzorerwa; 75 muzana kusvika ku90 muzana inorema-inowanikwa pamakore mashanu ekutevera.
- Ongororo ichangobva kuenzaniswa yakafananidza FBT yeBurlimia nervosa neBBCT yeBulimia Nervosa. Zvakawanikwa zvakaratidza kuti FBT yakatungamirira kukurumidza uye nekuchengetedza kuzvidzivirira kwevechidiki.
- Kutsvakurudza kwepakutanga uye zvidzidzo zvekare zvinoratidza zvakare kuti FBT inzira inogamuchirwa yevechidiki.
FBT inoita seinobudirira kwazvo kumhuri umo urefu hwehutano huri pasi pemakore matatu. Kutanga kupindura kwakanaka kune kurapwa (kazhinji nevhiki yechina) kunofanirwa kwekugara kwenguva yakareba kubudirira.
FBT Haisi Mhuri Yese
Vabereki vanondipa zvikonzero zvakawanda zvavanotenda kuti FBT haizovashandi. "Mwana wangu akwegura zvikuru." "Mwana wangu akazvimiririra." "Handina simba zvakakwana." "Takabatikana chaizvo." Handina kuwana chimwe chezvinhu izvi kuti zvive chikonzero chekubudirira kwekurapa kweFBT . Kutsvakurudza uye ruzivo rwangu rwechipatara zvinoratidza kuti mhuri dzakawanda dzinokwanisa kubudirira kuita FBT.
Zvisinei, hazvirevi kuti mhuri dzose. Izvo zvakasimba uye zvinoda kuzvipira kwakasimba nemhuri. Hazvikurudzirwi kumhuri umo vabereki vari mumuviri kana kuvhiringidza zvepabonde kana kushandisa zvisizvo. Izvo zvingasarudzwa zvakare kumhuri umo vabereki vanonyanya kutsoropodza.
Izvo zvakasarudzwa pamusoro apa zvinomirira zvishoma zvedambudziko. Mhuri dzakashandisa nzira iyi inowanzoshanda zvikuru uye ichionga kuti yakave chikamu chemhinduro. Ndinoona kuti kushamwaridzana nemhuri dzine kuzvipira kwekudzorera kwevana vavo kunondipa mubayiro kwandiri semuongorori.
> Sources:
> Dimitropoulos, G., Lock, J., Le Grange, D., & Anderson, K. Kurapa kwemhuri yevechirwere chekuchinja mumhuri yekurapa kwevechiri kuyaruka Kudya uye Matambudziko Okurema: Matambudziko Matsva, akanyorwa naKatherinerine L. Loeb, Daniel Le Grange , James Lock, 2015 Routledge.
> Le Grange, DL, Lock, J., Agras, WS, Bryson, SW, & Jo, B. (2015). Randomized Clinical Trial of Family-Based Treatment uye Kuchengetedza-Maitiro Anobatsira Vana Vechiduku Bulimia Nervosa. Nyaya yeAmerican Academy of Child & Adolescent Psychiatry , 54 (11), 886-894.e2. http://doi.org/ 10.1016 / j.jaac.2015.08.008
> Lock J, Le Grange D, Agras W, Moye A, Bryson SW, & Jo B. (2010). Randomized kliniki yekuenzanisa kuenzanisa mhuri-based treatment nevechiri kuyaruka-zvakananga kurapwa kwevamwe vari kuyaruka vane anorexia nervosa. Archives of General Psychiatry , 67 (10), 1025-1032. http://doi.org/ 10.1001 / archgenpsychiatry.2010.128
> Thornton, LM, Mazzeo, SE, & Bulik, CM (2011). Kuzvidzivirira Kwekudya Kunetseka: Nzira uye Nhasi Kuwana. Misoro Yemazuva Ano Mukurarama Neuroscience , 6 , 141-156. http://doi.org/ 10.1007 / 7854_2010_91