摘要
負面身體意象與飲食障礙問題已成為西方國家青少年族群極為普遍的健康問題。國內與飲食障礙有關的研究不多，且多限於臨床個案報告與個人危險因子的探討，少有從社會文化面向探討致病成因。而關於身體意象的研究也多以女性為對象，缺乏性別比較；即使少數同時包含兩性的研究結果也僅以量性統計分析呈現性別差異，缺乏對這些差異的實質意涵深入探討。
本研究試圖從社會文化面向探討青少年飲食障礙問題，分析媒體、同儕、家人等社會因素如何影響青少年身體意象及飲食障礙問題的發生，並進一步討論飲食障礙症中性別差異的社會意涵。研究結合質性與量性研究方法，前者包括臨床個案病歷、焦點團體訪談以及雜誌內容分析等，後者則包括健保住院資料及以台北、台南市之高中職男女學生共497名為對象的問卷調查。
研究結果顯示，青少年對自我身體意象普遍不滿意，而接觸流行時尚類的媒體訊息以及受媒體、同儕、家人影響程度愈高者，有較強的負面身體意象與飲食障礙傾向。在性別比較方面，青少女接觸媒體瘦身訊息的頻率及受同儕與家人體型評價較男生多，而其對體重增加的擔憂、纖瘦體型取向與節食、減重行為也較男生普遍，且對身體意象的不滿意與飲食障礙傾向亦顯著高於青少男。
本研究認為，流行文化對纖細體型的崇尚經由媒體傳播，透過人際互動過程中同儕與家人對外表體型的善意監督或嚴格批評，共同形塑出理想體型的社會壓力，進而影響青少年的負面身體意象與飲食障礙傾向。最後，性別角色在此區隔了社會壓力的影響，女性成了理想體型的主要約束對象，亦是其健康威脅的直接受害者。

Abstract
Negative body image and eating disturbances have become prevalent health problems among adolescents in Western countries. Few studies addressed the problem of eating disturbances in Taiwan and even these few are mostly limited to clinical case reports and to the investigation of personal risk factors. Very few examined socio-cultural factors. Further, most previous studies concerning body image focused on females only. Few of them addressed gender differences. Even among few studies that include both males and females, they used quantitative data to address the gender differences. There is a serious lack of substantive and qualitative analyses of the implications of the gender differences.
This study intends to examine the problem of eating disturbances in adolescents and analyze how the social factors, such as media, peers and families, influence their body image and eating disturbance problems. The study also discusses the social implication of the gender differences in eating disorders. The method of this study combines both qualitative and quantitative approaches. The data are collected from the clinical anamnesis, focus groups, magazines, National Health Insurance research database and a questionnaire survey. The sample of the latter includes 497 high school students from Taipei and Tainan City.
The results show that adolescents are generally dissatisfied with their body image. Those who are more exposed to the popular fashion messages from media and who are more influenced by media, peers and families show more negative body image and are more inclined to have eating disorders. Females, in contrast with males, are exposed to weight-lose messages more frequently and are more likely to be criticized of their body by peers and families. They are also more likely to worry about their weight gain; to have a drive for thinness; to be on diet; and to try to lose weight. Their dissatisfaction with their body image and their likelihood to have eating disorder problems are also significantly greater than their male counterparts.
The social pressure of ideal body image is constructed by the fashion and the culture toward the admiration of thinness, which is carried through media and through the friendly supervision and criticism by their peers and families. This social pressure subsequently leads to the adolescent’s negative body image and eating disturbances. Finally, the impact of this social pressure differs by gender, with females becoming the objects of restrain and the victims of health by the ideal body shape.

參考文獻
英文部分
1.Aleixo M. Eating disorders in adolescent boys: a review of the adolescent and young adult literature. Journal of Adolescent Health, 33(6): 427-435, 2003.
2.Andersen AE. Eating disorders in males. In: Brownell KD, Fairburn CG, eds. Eating disorders and obesity:a comprehensive handbook. New York:Guilford Press, 177-187, 1995.
3.Attie I, Brooks-Gunn J. Development of eating problems in adolescent girls：A longitudinal study. Developmental Psychology, 25:70-79, 1989.
4.Becker AE. Eating disorder. New England Journal of Medicine 340(14):1092-1098, 1999.
5.Borzekowski DL., Robinson TN., Killen JD. Does the camera add 10 pounds? Media use, perceived importance of appearance, and weight concerns among teenage girls. Journal of Adolescence Health, 26(1):36-41, 2000.
6.Byely L, Archibald AB, Graber J, Brooks-Gunn J. A prospective study of familial and social influences on girls’ body image and dieting. International Journal of Eating Disorder, 28(2):155-164, 2000.
7.Cash TF. The Multidimensional Body-self relations Questionnaire. Unpublished manuscript. Old Dominion Unversity, 1994.
8.Fairburn CG, Walsh BT. Atypical eating disorders. Eating disorders and obesity. Ed by Brownell K. D. & Fairburn, C. G. NY: Guilford, 1995.
9.Fichter M, Quadflieg N. Six-year course and outcome of anorexia nervosa. International Journal of Eating Disorder,26:359-385,1999.
10.Field A.E, Cheung L, Wolf AM, Herzog DB, Gortmaker SL, Colditz GA.. Exposure to the mass media and weight concerns among girls. Pediatrics, 103:3, E36, 1999.
11.Fisher M, Golden N, Katzman D. Eating disorder in adolescence：a background paper. Journal of Adolescent Health ,16:420-437,1995.
12.Fisher S. Development and Structure of The Body Image. Hillsdale, New Jersey: Lawrence Erlmaum Associates, Inc., Publishers, 1986.
13.Fombonne, E. Anorexia nervosa. No evidence of an increase. British Journal of Psychiatry, 166:462-471, 1995.
14.Garner DM, Olmstead MP, Polivy J. Development and validation of a multidimensional eating disorder inventory for anorexia nervosa and bulimia. International Journal of Eating Disorders, 2:15-34,1983.
15.Garner DM, Olmsted MP, Garfinkel PE. The eating attitudes test：psychometric features and clinical correlates. Psychological Medicine, 12:871-878,1982.
16.Garner DM, Olmsted MP, Polivy J. Development and validation of a multidimensional inventory for anorexia nervosa and bulimia. International Journal of eating disorder , 2:15-34,1983.
17.Grogan S. Body Image: Understanding Body Dissatisfaction in Men, Women and Children, London: Routledge,1999.
18.Harper G. Eating disorder in adolescent. Pediatr Rev,15:72-77,1994.
19.Hsu LK. Epidemioligy of the eating disorders. Psychiatric Clinical of North America ,19:681-700, 1996.
20.Joiner GW, Kashubeck S. Acculturation, body image, self- esteem, and eating-disorder symptomatology in adolescent Meaican women, 1996.
21.Jones, J. M., Bennett, S., Olmsted, M. P., Lawson, M. L., ＆ Rodin, G. Disordered eating attitudes and brhaviours in teenaged girls：a school- based study. Canadian Medical Association Journal, 165(5):547-552 ,2001.
22.Kaplan HI,Sadock BJ:Synopsis of Psychiatry.8th ed. Baltimore. Williams & Wilkins,720-731,1998.
23.Keel PK, Mitchell JE. Outcome in bulimia nervosa. American Journal of Psychiatry ,154:313-321, 1997.
24.Kirk G, Singh K, Getz H. Risk of eating disorders among female college athletes and nonathletes. Journal of College Counseling, 4:122 -132, 2001.
25.Kjelsas E, Bjornstrom C, Gotestam GK. Prevalence of eating disorders in female and male adolescents(14-15 years). Eating Behavior ,5:13-25, 2004.
26.Kohn M, Golden NH. Eating disorders in children and adolescents：epidemiology, diagnosis and treatment. Paediatric Drugs, 3(2):91-99, 2001.
27.Kuboki T, Nomura S, Ide M, Suematsu H, Araki S： Epidemiology data on aneraxia nervosa in Japan. Psychiatry Research ,62:285-256,1996.
28.Lavine, Howard, Sweeney, Donna,Wagner SH. Depicting women as sex objects in television advertising：Effects on body dissatisfaction.Personality ＆Social Psychology Bulletin,25(8):1049-1058,1999.
29.Lee AM, Lee S. Disordered eating and its psychological correlates among Chinese adolescent females in Hong Kong. International Journal of Eating Disorders, 20:177-183. 1996.
30.Lee S, Chiu HF, Chen CN. Anerexia nervosa in Hong Kong. Why not more in Chinese? British Journal of Psychiatry ,154:683-688,1989.
31.Lee S, Hsu LK, Wing YK：Bulimia nervosa in Hong Kong Chinese patient. British Journal of Psychiatry, 161:545-551. 1992;
32.Lee S. Disordered Eating in tree communities of China：a comparative study of female high school students in Hong Kong, Shenzhen, and rural Hunan. International Journal of eating disorder, 27:317-327, 2000.
33.Lee S. Anorexia nervosa in Hong Kong：a Chinese perspective. Psychological Medicine , 21:703-711,1991.
34.Levine MP, Smolak L, Hayden H. The relation of sociocultural factors eating attitude behavior among middle school. Journal of Early Adolescence, 14(4) :471-490, 1994.
35.Lucas AR, Beard CM, O’Fallon WM, Kurland L T. Fifty- year trends in the incidence of anorexia nervosa in Rochister, Minnesota: a population-based study. American Journal Psychiatry, 148:917-922, 1991.
36.Miller, M. N., Verhegge, R., Miller, B. E., & Pumariega, A. J. Assessment of risk of eating disorders among adolescents in Appalachia. Journal of the American Academy of Child & Adolescent Psychiatry, 38(4): 437-443, 1999.
37.Mukai T, Crago M, Shisslak CM：Eating attitudes and weight preoccupation among female high school students in Japan. Journal of Child Psychology & Psychiatry & Allied Disciplines ,35(4):677-688,1994.
38.Much JL, Cash TF. (1997). Body- Image Attitudes: What Difference Does Gender Make? Journal of Applied Social Psychology, 27(16), 1438-1452.
39.O’Dea, Jennifer. The new self-esteem approach for the prevention of body image and eating problems in children and adolescents. Healthy Weight Journal, 16(6): 89-93, 2002.
40.Paxton SJ, Schutz HK, Wertheim EH, Muir SL. Friendship clique and peer influences on body image concerns,dietary restraint,extreme weight-loss behaviors,and binge eating in adolescent girls. Journal of Abnormal Psychology, 108(2):255-266, 1999.
41.Paxton SJ, Wertheim EH, GibbonsG, Szumkler GI, Hiller L, Petrovich JL. Body image satisfaction, dieting belief, and weight loss behaviors in adolescent girls and body. Journal of Youth and Adolescent, 20(3):361-379,1991.
42.Polivy J, Peter HC. Causes of eating disorders. Annual Review Psychology, 53,:187-213, 2002.
43.Rosen JC, Gross J, Vara L. Psychological adjustment of adolescents attempting to lose or gain weight. Journal of Consulting and Clinical Psychology, 5(5): 742-747, 1987.
44.Sheryl A.M, Marita PM. The influence of societal factors on female body image. Journal of Social Psychology, 137(6):708-727, 1997.
45.Soundy TJ, Lucas A.R, Suman VJ, Melton LJ. Bulimea nervosa in Rochister, Minnesota from 1980 to 1990. Psychological Medicine, 25(5): 1065-1072,1995.
46.Stein D, Meged S, Bar-Hanin T, Blank S, Elizur A, Weizman A. Partial eating disorders in a community sample of female adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 36:116-1123, 1997.
47.Steiner H. , Lock J. Anorexia nervosa and bulimia nervos children and adolescents: a review of the past 10 years. Journal of the American Academy of Child & Adolescent Psychiatry, 37(4):352-359,1998.
48.Steinhausen HC. Annotation. Outcome of aneorexia nervosa in the younger patient. Journal of Child Psychology & Psychiatry & Allied Disciplines ,38:271-276, 1997.
49.Steinhausen H-C. Treatment and outcome of adolescent anorexia nervosa. Hormone Research ,43:168-170, 1995.
50.Stice E, Shaw HE. Role of body dissatisfaction in the onset and maintenance of eating pathology：A synthesis of research findings. Journal of Psychosomatic Reseach, 53(5): 985-993, 2002.
51.Stice, E., Schupak-Neuberg, E., Shaw, H. E., & Stein, R. I. Relation of media exposure to eating symptomatology: An examination of mediating mechanisms. Journal of Abnormal Psychology, 13(4): 836-840, 1994.
52.Sullivan PF. Mortality in anorexia nervosa. American Journal of Psychiatry ,152:1073-1076, 1995
53.Sullivan, P. F. Mortality in Anorexia Nervosa. American Journal of Psychiatry, 152(7) :1073-1074, 1995.
54.Wercheim, E. H., Paxton, S. J., Schutz, H. K., & Muir, S. L. Why do adolescent girls watch their weight? An interview examing sociolcultural pressure stobethin . Journal of Psychosomatic Research, 42(4):345-355,1997.

中文部分
55.王麗瓊：國中生身體意象之相關因素分析研究；國立台灣師範大學衛生教育學系碩士論文，2001。
56.古琪雯：青少女體型不滿意、社會體型焦慮與飲食異常傾向之關係研究；台灣師範大學衛生教育研究所碩士論文, 2003.
57.民生報報導，資訊來源為台北榮民總醫院，「飲食障礙者追蹤調查」，民生報，1999年12 月3 日。
58.伍連女：台北市高職學生身體意象與運動行為之研究；國立台灣師範大學衛生教育研究所碩士論文, 1998.
59.李曉蓉：青少年身體意象與自尊、沮喪相關之研究；高雄師範大學教育研究所碩士論文, 1997.
60.林宜親，林薇：青少年體型意識與節制飲食行為之研究。中華衛誌 2000;19(1)：33-41。
61.林宜親：青少年體型意識與節制飲食行為之研究；台灣師範大學家政教育研究所碩士論文, 1998.
62.洪建德、鄭淑慧：台北地區女學生的身體形象和飲食行為。中華衛誌 11（4）:316-327, 1992.
63.孫秀蕙：媒體廣告對青少年性別認同與性別刻板印象的行塑與鬆動。教育部九十一年度委託研究計畫，2003。
64.孫家瑞、馮煥光：厭食症及暴食症的診斷與治療。國防醫學23(4)：338-342, 1996.
65.張錦華：女為悅己者容?瘦身廣告的影響研究—以台北市一般高中職學生為例。民意研究季刊203:61-90,1998.
66.莊文芳：影響台北市青少年對身體意象認知相關因素之探討；陽明大學衛生福利研究所碩士論文, 1998.
67.郭靜如：學童身體外表知多少？－淺談國小學童之身體意象；師友 395: 25-29, 2000.
68.陳玉欣：國中生飲食行為及相關因子的流行病學研究；國立台灣大學流行病學研究所碩士論文, 1999.
69.陳冠宇：某高中職的暴食症盛行率。台灣精神醫學14(4)：279-89,2000.
70.曾美智，李明濱，李宇宙：我國飲食疾患的臨床研究。中華精神醫學3：17-28,1989.
71.曾美智，李明濱：厭食症與暴食症。當代醫學18：74-80,1991.
72.曾美智，柯慧貞，李明濱：中文版飲食障礙問卷之信度和效度研究。台灣醫學5(4)：379-388,2001.
73.葉啟斌、江漢光、魯思翁：飲食疾患-神經性厭食症與神經性暴食症。國防醫學25(5): 408-411,1997.
74.賈文玲：青少年身體意象與自尊、社會因素關係之研究。中國文化大學兒童福利研究所碩士論文，2002。
75.劉仲冬：厭食症迷思。張老師月刊70：70-72,1997.
76.蔡季蓉：台北市國中生體型意識滿意度與健康知識、健康行為相關性之研究；台灣師範大學衛生教育研究所碩士論文, 1990.
77.蕭芳惠，林薇：台北市高中女生的體型意識及飲食異常傾向之研究。衛生教育學報 11：107-127,1998.
78.賴靖薇：青少年異常飲食行為傾向與內外控人格特質之相關研究；國立陽明大學社區護理研究所碩士論文, 2002.