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Eating disorders are a group of serious psychological conditions that can have grave impacts on a person's physical health.
饮食失调是一组严重的心理疾病，会对一个人的身体健康产生严重影响。
And they're way more common than you probably think.
它们比你想象的要常见得多。
That's because, most of the time, when people talk about "eating disorders," they're only talking about the ones that involve eating next to nothing or purging.
这是因为，大多数时候，当人们谈论“饮食失调”时，他们只是谈论那些几乎不吃东西或节食的人。
And it turns out, those conditions don't make up the majority of diagnoses.
事实证明，这些情况远不能构成大多数的诊断。
In recent years, research has begun to highlight the wide variation in eating disorder symptoms.
近年来，研究开始强调饮食失调症状的广泛差异。
And that's led to a more complete understanding of how these disorders arise, and how to recognize them, so hopefully, more people can get the help they need.
这使得人们对这些疾病的起因，以及如何识别有了更全面的了解，所以希望更多的人能够得到需要的帮助。
Eating disorders are incredibly complex mental health conditions which are influenced by a variety of environmental and genetic factors.
饮食失调是极其复杂的心理健康状况，受多种环境和遗传因素的影响。
But when people talk about eating disorders, usually, only two specific conditions are brought up.
但是，当人们谈论饮食失调时，通常只会出现两种特定的情况。
The first is Anorexia Nervosa—or just anorexia, for short which is characterized by very restricted food intake, often to the point of becoming too thin and malnourished to survive.
第一种是神经性厌食症或只是厌食症，简而言之，其特点是摄入非常有限的食物，往往会变得过瘦，同时出现营养不良而无法生存。
The other is Bulimia Nervosa.
另一种是神经性贪食症。
People with bulimia generally end up in cycles of out of control eating or "binging" followed by purging behaviors.
暴食症患者通常最后会形成失控性进食或“暴食”的循环，随后出现节食行为。
Both of these involve attempts to limit weight gain in some way, and most often occur alongside a condition known as body dysmorphia—a distressing preoccupation with your own perceived physical flaws.
这两种情况都涉及到以某种方式限制体重增加，而且大多数情况下都会伴随出现一种称为身体畸形的疾病，痛苦地关注自己的身体缺陷。
But even though these two disorders are the ones you might hear about most often, they don't make up the majority of eating disorder diagnoses; in some studies, they account for a quarter or less.
但是，尽管你会经常听人提起这两种疾病，但它们并不能构成大多数饮食失调的诊断；在一些研究中，它们所占比重为四分之一或更少。
So the most commonly diagnosed eating disorder is known as OSFED:
最常见的饮食失调称为OSFED：
Other Specified Feeding or Eating Disorders.
其他特定性进食障碍。
If that seems vague...it is meant to be.
这看起来含糊不清，其实这就是目的。
It's kind of a catch all condition.
这样就描述了所有病症。
Not everyone with it will have exactly the same symptoms,
不是每个人都有完全相同的症状，
but they generally meet a mix of the criteria for other eating disorders.
但它们通常符合其他饮食失调的混合标准。
And they may have other behavioral symptoms.
他们可能还有其他行为方面的症状。
For example, many people with eating disorders report improperly using laxatives to lose weight or feel empty.
例如，许多饮食失调患者报告，不恰当地使用泻药减肥或让自己感动腹中空空。
The thinking behind this is that these drugs ‘rush' food through a person's system, and calories or nutrients won't be absorbed if everything's passed out of the body very quickly.
其理念是，这些药物会使食物快速通过人体系统，如果一切都迅速从身体中排出，热量或营养素就不会被吸收。
But, that's not how any of this works.
但是，这都不是它的工作原理。
Laxatives stimulate the large intestine, not the small intestine where all that food actually gets absorbed.
泻药刺激大肠，而不是小肠，因为小肠实际上吸收所有的食物。
And just to be 100% clear: laxative abuse is incredibly dangerous, and can have severe, potentially life threatening consequences.
只是要100%地清楚：泻药滥用非常危险，可能会造成威胁生命的严重后果。
Rather than reducing calories, the body mostly loses water, so people that improperly use laxatives can become dangerously dehydrated.
人体主要会失水，而不是减少卡路里，因此不适当地使用泻药可能会出现脱水，威胁生命。
And pharmaceutical misuse is an unfortunately common theme when it comes to eating disorders.
遗憾的是，说道饮食失调，药物滥用是一个共同的主题。
For example, people who have diabetes as well as an eating disorder often engage in insulin undertreatment or omission,
例如，患有糖尿病和饮食失调的人通常会出现胰岛素治疗不足或疏漏，
a potentially deadly behavior that aims to force weight loss by reducing your body's ability to metabolize food.
这是一种潜在的致命行为，旨在通过降低身体代谢食物的能力来强制减肥。
Though not identified as its own disorder by the DSM-5, this practice is so common that it's recently become known as diabulimia— a combination of diabetes and bulimia.
尽管DSM-5没有将其确定为本手册的疾病，但这种做法非常普遍。人们最近将其称为糖尿病-贪食症综合症。
And it increases the odds of diabetes complications like kidney damage, nerve damage and blindness.
它增加了糖尿病并发症的几率，如肾损伤、神经损伤和失明。
These are severe behaviors, so if they remain unnoticed, it's because they're done in private.
这些都很严重，如果没注意到，那是因为它们是秘密进行的。
And that's part of why the prevalence of eating disorders is higher than you might think.
这就是为什么饮食失调的患病率比想象中高的部分原因。
But there's more to it than that.
但是，原因还有很多。
A larger, more sinister reason eating disorders can go undiagnosed is cultural.
饮食失调未被诊断出来的一个更大、更可怕的原因可能来自于文化。
The scientific community has only recently begun to deal with the fact that most eating disorder research has been done mainly or exclusively on women, and specifically, on cisgender women trying to meet unhealthy ideals for feminine bodies.
科学界最近才开始处理这样一个事实：大多数饮食失调的研究主要或专门针对女性，特别是针对那些想拥有病态女性形象的人。
People with eating disorders who aim for traditionally masculine physical ideals can present very differently.
想拥有传统男性化身材的饮食失调患者的目标，可能是完全不同的情况。
They tend to be aiming to bulk up rather than get thin, for example.
例如，他们的目标往往不是变瘦，而是增加体重。
Studies have found that roughly 90% of American men feel that way, though the US is a bit of an outlier.
研究发现，大约90%的美国男性有这种感觉，尽管美国情况有些特异。
In other countries, that number is lower.
在其他国家，这个数字更低。
Like, in Uganda and Ukraine, the figure is 49% and 69%, respectively.
就像在乌干达和乌克兰一样，这个数字分别是49%和69%。
Of course, wanting to gain muscle doesn't mean you have a disorder.
当然，想要获得肌肉并不意味着你要得病。
But it does illustrates how prevalent the pressure is to have a certain physique.
但它确实说明，拥有某种体型的压力是多么的普遍。
And a lot of the ways people might go about getting more muscular—like dieting, exercising, and being conscious of nutrient intake—can be taken to pathological extremes.
有很多能变得更强壮的方式，比如节食、锻炼、注意营养摄入，但它们都可能走向极端。
For example, if a person makes rigid rules for consumption — like "50 push ups before I can have a protein shake" — that's wandering into unhealthy behavior territory.
例如，如果一个人制定了严格的饮食规则，比如“在吃高蛋白奶昔可前，先做50个俯卧撑”，那就迈入了不健康的行为领域。
Such food rules fall under the broader umbrella of disordered eating behaviors because they tend to stem from — and lead to — people thinking too much about food and eating.
这种饮食规则属于更广泛的无序饮食行为的保护伞，因为它们往往源于、并导致人们对食物和进食过度思考。
And they usually become more restrictive over time.
随着时间的推移，他们通常会变得更加严格。
People trying to bulk up may also struggle with a lot of the same psychological issues people with anorexia or bulimia do, like feelings of guilt, inadequacy, and unattractiveness.
试图增强体质的人可能也会与厌食症或暴食症患者许多相同的心理问题作斗争，比如内疚感、机能不全和缺乏吸引力。
And they might even have muscle dysmorphia, an unhealthy preoccupation and dissatisfaction with the perceived size of their muscles, or use bodybuilding supplements excessively.
他们甚至可能有肌肉畸形，病态专注和对肌肉大小的不满意，或者过度使用健美补充剂。
The problem is, these kinds of things are often seen as ‘normal' for guys, or even healthy, so many people don't even realize what they're experiencing is a disorder.
问题是，这类事情对于男人来说通常被认为是“正常”的，甚至是健康的。所以，很多人甚至没有意识到他们得病了。
And even if they do know that they have body or food issues, they may not seek treatment because eating disorders are often stigmatized as like a "girl" or "gay" thing.
即使他们知道自己有身体或食物方面的问题，也可能不会寻求治疗。因为饮食失调常常被认为是“女孩”或“同性恋”才会有的问题。
Of course, it's not just men who present with eating disorder symptoms like these.
当然，不仅是男性会出现这种饮食失调症状。
Research published in 2017 surveyed 101 women who post so-called ‘fitspiration' pics on Instagram — that's fitness inspiration photos, for those of us not familiar with the lingo
2017年发表的一项研究中，调查了101名在Ins上发布所谓“fitspiration”照片的女性。对于不熟悉该术语的人，我解释一下，这是健身动力照片。
—and compared them with 102 women who post travel photos.
研究人员将她们与102位发布旅行照片的女性进行对比。
The fitspiration posters scored higher on measures of disordered eating, and nearly 1/5 of them were considered at risk for a clinically relevant eating disorder,
发布fitspiration照片的女性，在饮食失调方面得分较高。其中近1/5的人有患上临床相关饮食失调症的风险，
because they showed an especially high drive for muscularity and compulsive exercise.
因为她们显示出对于发达的肌肉和强迫性运动的高度向往。
So just how many people unknowingly have this kind of eating disorder is unclear — but it's almost guaranteed to be higher than previous estimates.
所以，究竟有多少人在不知情的情况下患上这种饮食失调还不清楚，但几乎可以肯定的是，这一数字高于先前的估计。
And there's unfortunately more.
人数会更多，真是遗憾。
You see, not all eating disorders have to do with unrealistic body ideals.
不是所有的饮食失调都与不现实的身体意念有关。
A good example is Avoidant/Restrictive Food Intake Disorder, or ARFID.
一个很好的例子是避免/限制性食物摄入障碍，也叫ARFID。
The disorder was newly defined when the DSM-5 published in 2013,
这种疾病是在2013年DSM-5发布时给出的最新定义，
and it's characterized by a persistent failure to meet nutritional or energy needs with at least one more extreme consequence stemming from that, like needing a feeding tube.
其特点是持续不能满足营养或能量需求，至少还有产生一个更为极端的后果，比如需要依靠进食管。
But people with ARFID don't have body image distortion and aren't looking to get thin or buff — it's food or the act of eating itself that's the issue.
但是，ARFID患者不存在身体意向扭曲，也不想变瘦或变胖，问题在于食物或进食本身。
A study from 2014 found that those who meet the criteria for ARFID more frequently report issues with things like the texture, flavor, or color of their food, or even a fear of choking.
2014年的一项研究发现，那些符合ARFID标准的患者更经常报告与食物口感、味道或颜色相关的问题，甚至会担心出现哽噎。
They often also have intense fear of trying or being made to eat new foods.
他们也经常对尝试或被强迫吃新食物有强烈的恐惧。
So in order to avoid all these potential anxiety triggers, they just kind of avoid everything to do with the foods that make them uncomfortable,
因此，为了避免触发焦虑的所有潜在因素，他们会避开与使他们不舒服的食物相关的所有事情，
even if that means eating very little or not getting the nutrients they need.
即使这意味着吃得很少或没有获得需要的营养。
Generally, ARFID is associated with children, but these aren't just cases of picky eating.
一般来说，ARFID与儿童有关，但这可不仅是挑食的病例。
Kids grow out of that.
孩子们长大后就不再挑食了。
People with ARFID don't, and symptoms can continue into adulthood.
但ARFID患者不是这样，他们的症状会持续到成年。
As of yet, there's no consensus on how prevalent ARFID is, which makes sense, as it's a recently defined disorder.
到目前为止，还没有关于ARFID的患病率有多普遍的共识。这很容易理解，因为它是一种新被定义的疾病。
But it seems to be more common in boys, and even if it's not very common, it broadens our understanding of what an eating disorder is and who has them.
但这种疾病似乎在男孩身上更为常见，即使它并不常见，也扩大了我们对什么是饮食失调以及谁会患病的理解。
And with increased awareness of just how diverse eating disorders can be, hopefully, we can get much better at identifying them and how they arise — which will make us even better at treating them.
随着人们对饮食失调的多样性认识的提高，我们希望能更好地识别出这些病症，并了解它们的病因，这将使我们更好地进行治疗。
Because although it's often a long, hard road, recovery is possible — and it starts with a proper diagnosis.
因为尽管治疗之路漫长而艰难，但患者有可能康复，不过要先能够正确诊断。
Thanks for watching this episode of SciShow Psych!
感谢收看这一集的心理科学秀！
If you're concerned that you or someone you care about may have an eating disorder, there are people who can help.
如果你担心自己或你关心的人可能患有进食障碍，有人可以帮助你。
In the US, you might want to check out the National Eating Disorders Association website, which is linked in the description.
在美国，你可以看看全国饮食失调协会的网站，可以在描述中找到网站链接。
There, you can find a screening tool which can help determine if you should seek professional help, as well as options for chatting online or over the phone with trained volunteers.
还能在那找到筛选工具，帮助你确定是否应该寻求专业帮助，以及在线聊天或通过电话与受训志愿者交谈的选项。
Also 24/7 Crisis Support is available via text by sending NEDA to 741-741.
此外，向741-741发送NEDA，通过短信提供全天候危机支持。
