一位診斷為厭食症的個案，下列哪項觀察顯示其狀況正在改善？

厭食症（Anorexia nervosa）是一種複雜的進食疾患（Eating disorder），其核心特徵是極度害怕體重增加、對體重的認知扭曲，以及對食物攝取嚴格限制，導致體重顯著下降。治療的目標不僅是恢復體重，更重要的是處理其潛在的心理因素，特別是對身體形象的負面認知。 正確答案 A，病人開始討論對身體形象的不滿（The client discusses feelings of body dissatisfaction），是顯示病人狀況正在改善的重要心理指標。這表示病人開始願意探索、表達其內在的負面想法和情緒，是心理治療（如認知行為療法 CBT, Cognitive Behavioral Therapy）的進展。願意談論這些困擾，意味著病人開始對自己的想法產生覺察，並可能開始接受改變的可能，這是建立健康自我認同的基礎。 錯誤選項分析： A. 病人開始吃完餐盤上的所有食物：雖然恢復正常的飲食模式是治療目標之一，但單純的「吃光」可能只是病人為了取悅治療者或避免懲罰而採取的行為，並不一定代表其心理狀態的改善。病人可能仍在強迫自己進食，內心充滿罪惡感或焦慮。 B. 病人與同儕進行健康的社交活動：社交活動的參與是恢復社會功能的一部分，但若病人只是為了「看起來正常」而參與，而其內在的身體形象問題並未解決，那麼這種改善可能只是表面的。真正的改善應包含心理層面的轉變。 D. 病人拒絕在治療期間運動：雖然過度運動是厭食症的常見行為，但「拒絕運動」本身並不直接代表心理上的改善。病人可能出於恐懼、無力感或其他原因而拒絕，這需要進一步的評估。重點在於病人是否能以健康的、平衡的方式看待運動與身體。 因此，評估厭食症病人的改善，應著重於其心理狀態的轉變，包括對身體形象的認知、情緒表達能力，以及對自身價值的看法，而不僅僅是外在行為的改變。

Anorexia nervosa is a complex eating disorder characterized by an intense fear of weight gain, distorted perception of body weight, and severe restriction of food intake leading to significant weight loss. The goal of treatment is not only to restore weight but, more importantly, to address the underlying psychological factors, especially negative body image. The correct answer, A, that the client is beginning to discuss feelings of body dissatisfaction, is an important psychological indicator that the client's condition is improving. It shows that the client is becoming willing to explore and express internal negative thoughts and emotions, which represents progress in psychotherapy (such as cognitive behavioral therapy, CBT). Being willing to talk about these struggles means the client is developing awareness of their thinking and may be becoming open to change, which is the foundation for building a healthy self-identity. Analysis of incorrect options: A. The client begins to eat everything on the plate: although restoring a normal eating pattern is one treatment goal, simply finishing meals may reflect a behavior aimed at pleasing the treatment team or avoiding consequences and does not necessarily indicate psychological improvement. The client may still be forcing food intake while internally experiencing guilt or anxiety. B. The client engages in healthy social activities with peers: social participation is part of restoring social functioning, but if it is only to "appear normal" while underlying body-image issues remain unresolved, the improvement may be superficial. Genuine improvement should include psychological change. D. The client refuses to exercise during treatment: although excessive exercise is common in anorexia nervosa, refusing to exercise does not in itself indicate psychological improvement. The client may refuse out of fear, powerlessness, or other reasons, and this requires further assessment. What matters is whether the client can view exercise and the body in a healthy, balanced way. Therefore, evaluation of improvement in a client with anorexia nervosa should focus on psychological change—perception of body image, ability to express emotions, and view of self-worth—rather than on external behavior alone.