中国神经性贪食诊疗专家共识

doi:10.12114/j.issn.1007-9572.2023.0443

中国全科医学 ›› 2023, Vol. 26 ›› Issue (36): 4487-4497.DOI: 10.12114/j.issn.1007-9572.2023.0443

• 指南·共识 • 下一篇

中国神经性贪食诊疗专家共识

中华医学会心身医学分会进食障碍协作学组, 中华医学会精神医学分会进食障碍研究协作组, 陈妍¹, 陈涵¹, 刘兰英¹, 孔庆梅², 乔慧芬³, 张岚⁴, 李雪霓², 匡桂芳⁵, 张大荣², 栗克清⁶, 王振¹^,^*(), 陈珏¹^,^*()

1．200030　上海市，上海交通大学医学院附属精神卫生中心
2．100091　北京市，北京大学第六医院　北京大学精神卫生研究所　国家卫生健康委员会精神卫生学重点实验室（北京大学）　国家精神心理疾病临床医学研究中心（北京大学第六医院）
3．210024　江苏省南京市，南京医科大学附属脑科医院
4．610041　四川省成都市，四川大学华西医院心理卫生中心
5．266075　山东省青岛市，青岛大学附属妇女儿童医院
6．071000　河北省保定市，河北省精神卫生中心

收稿日期:2023-07-09 修回日期:2023-07-21 出版日期:2023-12-20 发布日期:2023-08-06
通讯作者: 王振, 陈珏
基金资助:
国家自然科学基金面上项目(82071545); 上海市科学技术委员会医学创新研究专项项目(20Y11906500); 上海市卫生健康委员会面上项目(202140092); 医工交叉重点项目(YG2022ZD026); 上海市精神心理疾病临床医学研究中心(19MC1911100)

Chinese Expert Consensus on the Diagnosis and Treatment of Bulimia Nervosa

Eating Disorders Coordination Group of the Psychosomatic Medicine Society of the Chinese Medical Association, Eating Disorders Research Collaboration Group of the Psychiatric Medicine Society of the Chinese Medical Association, CHEN Yan¹, CHEN Han¹, LIU Lanying¹, KONG Qingmei², QIAO Huifen³, ZHANG Lan⁴, LI Xueni², KUANG Guifang⁵, ZHANG Darong², LI Keqing⁶, WANG Zhen¹^,^*(), CHEN Jue¹^,^*()

1. Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
2. Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100091, China
3. Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing 210024, China
4. Mental Health Center, West China Hospital, Sichuan University, Chengdu 610041, China
5. Women and Children's Hospital, Qingdao University, Qingdao 266075, China
6. Hebei Mental Health Center, Baoding 071000, China

Received:2023-07-09 Revised:2023-07-21 Published:2023-12-20 Online:2023-08-06
Contact: WANG Zhen, CHEN Jue

分享到

摘要/Abstract

摘要： 神经性贪食是以反复发作的暴食和防止体质量增加的补偿行为，以及对体形和体质量过度关注为特征的一类进食障碍。神经性贪食患者存在紊乱的进食行为，导致电解质异常，出现胃肠道疾病、代谢和内分泌紊乱等躯体问题；其次常共病双相情感障碍、抑郁症、物质使用障碍等多种精神障碍，需引起重视。然而，目前在中国对于神经性贪食，乃至进食障碍不能早期识别和诊治，导致病程迁延。因此，在中华医学会心身医学分会进食障碍协作学组的组织下，联合中华医学会精神医学分会进食障碍研究协作组，由12名专家包括精神科医师和循证医学专家，组成专家组，基于循证医学证据、国内外指南与专家共识、专家经验等制订本专家共识，以期提高国内精神科专业人员和全科医师对神经性贪食的识别和诊治水平。

关键词: 神经性贪食, 心理治疗, 药物治疗, 诊疗指南, 指南

Abstract:

Bulimia nervosa is a type of eating disorders characterized by recurrent binge eating and compensatory behaviors to prevent weight gain, as well as excessive concern about body shape and mass. The patients with bulimia nervosa present with disturbed eating behavior, resulting in electrolyte abnormalities, gastrointestinal disorders, metabolic and endocrine disorders and other physical problems; secondly, the bulimia nervosa patients are often co-morbid with a variety of mental disorders such as bipolar disorder, depression, substance use disorders, which need to be taken seriously. However, bulimia nervosa and even eating disorders cannot be recognized and diagnosed at an early stage in China, which leads to a prolonged course of the disease. Therefore, under the organization of the Eating Disorders Coordination Group of the Psychosomatic Medicine Society of the Chinese Medical Association, in conjunction with the Eating Disorders Research Collaboration Group of the Psychiatric Medicine Society of the Chinese Medical Association, this expert consensus was formulated by 12 experts in the field of psychiatry and evidence-based medicine based on evidence-based medicine, domestic and foreign guidelines and expert consensus and expert experience, in order to improve the recognition, diagnosis and treatment of bulimia nervosa by psychiatric professionals and general practitioners in China.

Key words: Bulimia nervosa, Psychological treatment, Drug treatment, Diagnostic and treatment guideline, Guidelines

中华医学会心身医学分会进食障碍协作学组,中华医学会精神医学分会进食障碍研究协作组,陈妍,等. 中国神经性贪食诊疗专家共识[J]. 中国全科医学, 2023, 26(36): 4487-4497. DOI: 10.12114/j.issn.1007-9572.2023.0443.
Eating Disorders Coordination Group of the Psychosomatic Medicine Society of the Chinese Medical Association,Eating Disorders Research Collaboration Group of the Psychiatric Medicine Society of the Chinese Medical Association,CHEN Yan, et al. Chinese Expert Consensus on the Diagnosis and Treatment of Bulimia Nervosa[J]. Chinese General Practice, 2023, 26(36): 4487-4497. DOI: 10.12114/j.issn.1007-9572.2023.0443.

图/表 2

参考文献 72

[1]	王向群，王高华. 中国进食障碍防治指南[M]. 北京：中华医学电子音像出版社，2015.
[2]	陈珏. 进食障碍[M]. 北京：人民卫生出版社，2013.
[3]	HORNBERGER L L, LANE M A, Committee on Adolescence. Identification and management of eating disorders in children and adolescents[J]. Pediatrics，2021,147(1):e2020040279. DOI：10.1542/peds.2020-040279.
[4]	LOCK J, LA VIA M C, American Academy of Child and Adolescent Psychiatry （AACAP） Committee on Quality Issues （CQI）. Practice parameter for the assessment and treatment of children and adolescents with eating disorders[J]. J Am Acad Child Adolesc Psychiatry，2015,54(5):412-425. DOI：10.1016/j.jaac.2015.01.018.
[5]	National Guideline Alliance （UK）. Eating Disorders：Recognition and Treatment[M]. London：National Institute for Health and Care Excellence （NICE），2017.
[6]	GALMICHE M, DÉCHELOTTE P, LAMBERT G，et al. Prevalence of eating disorders over the 2000-2018 period：a systematic literature review[J]. Am J Clin Nutr，2019,109(5):1402-1413. DOI：10.1093/ajcn/nqy342.
[7]	梅莉，陈珏. 中国大陆进食障碍患者患病状况调查[J]. 临床精神医学杂志，2021,31(1):80-81. DOI：10.3969/j.issn.1005-3220.2021.01.024.
[8]	MAIRS R, NICHOLLS D. Assessment and treatment of eating disorders in children and adolescents[J]. Arch Dis Child，2016,101(12):1168-1175. DOI：10.1136/archdischild-2015-309481.
[9]	TREASURE J, DUARTE T A, SCHMIDT U. Eating disorders[J]. Lancet，2020,395(10227):899-911. DOI：10.1016/S0140-6736(20)30059-3.
[10]	American Psychiatric Association. Diagnostic and statistical manual of mental disorders，fifth edition，text revision[M]. Washington：American Psychiatric Association，2022.
[11]	HERUC G, HURST K, CASEY A，et al. ANZAED eating disorder treatment principles and general clinical practice and training standards[J]. J Eat Disord，2020,8(1):63. DOI：10.1186/s40337-020-00341-0.
[12]	古练，陈珏，黄悦，等. 进食障碍检查自评问卷6.0中文版在女性进食障碍患者中应用的效度和信度[J]. 中国心理卫生杂志，2017,31(5):350-355. DOI：10.3969/j.issn.1000-6729.2017.05.003.
[13]	KANG Q, CHAN R C K, LI X P，et al. Psychometric properties of the Chinese version of the eating attitudes test in young female patients with eating disorders in mainland China[J]. Eur Eat Disord Rev，2017,25(6):613-617. DOI：10.1002/erv.2560.
[14]	Scottish Intercollegiate Guidelines Network（SIGN）. Eating disorders 2022[EB/OL].[2023-02-26].
[15]	SVALDI J, SCHMITZ F, BAUR J，et al. Efficacy of psychotherapies and pharmacotherapies for bulimia nervosa[J]. Psychol Med，2019,49(6):898-910. DOI：10.1017/S0033291718003525.
[16]	GRANGE D L, CROSBY R D, RATHOUZ P J，et al. A randomized controlled comparison of family-based treatment and supportive psychotherapy for adolescent bulimia nervosa[J]. Arch Gen Psychiatry，2007,64(9):1049-1056. DOI：10.1001/archpsyc.64.9.1049.
[17]	GRANGE D L, LOCK J, AGRAS W S，et al. Randomized clinical trial of family-based treatment and cognitive-behavioral therapy for adolescent bulimia nervosa[J]. J Am Acad Child Adolesc Psychiatry，2015,54(11):886-894.e2. DOI：10.1016/j.jaac.2015.08.008.
[18]	STEFINI A, SALZER S, REICH G，et al. Cognitive-behavioral and psychodynamic therapy in female adolescents with bulimia nervosa：a randomized controlled trial[J]. J Am Acad Child Adolesc Psychiatry，2017,56(4):329-335. DOI：10.1016/j.jaac.2017.01.019.
[19]	KOTLER L A, DEVLIN M J, DAVIES M，et al. An open trial of fluoxetine for adolescents with bulimia nervosa[J]. J Child Adolesc Psychopharmacol，2003,13(3):329-335. DOI：10.1089/104454603322572660.
[20]	COUTURIER J, ISSERLIN L, NORRIS M，et al. Canadian practice guidelines for the treatment of children and adolescents with eating disorders[J]. J Eat Disord，2020,8:4. DOI：10.1186/s40337-020-0277-8.
[21]	邹蕴灵，陈珏. 认知行为疗法在进食障碍治疗中的应用[J]. 临床精神医学杂志，2019,29(3):214-215. DOI：10.3969/j.issn.1005-3220.2019.03.025.
[22]	SLADE E, KEENEY E, MAVRANEZOULI I，et al. Treatments for bulimia nervosa：a network meta-analysis[J]. Psychol Med，2018,48(16):2629-2636. DOI：10.1017/S0033291718001071.
[23]	ZERWAS S C, WATSON H J, HOFMEIER S M，et al. CBT4BN：a randomized controlled trial of online chat and face-to-face group therapy for bulimia nervosa[J]. Psychother Psychosom，2017,86(1):47-53. DOI：10.1159/000449025.
[24]	FAIRBURN C G, COOPER Z, DOLL H A，et al. Transdiagnostic cognitive-behavioral therapy for patients with eating disorders：a two-site trial with 60-week follow-up[J]. Am J Psychiatry，2009,166(3):311-319. DOI：10.1176/appi.ajp.2008.08040608.
[25]	LINARDON J, FAIRBURN C G, FITZSIMMONS-CRAFT E E，et al. The empirical status of the third-wave behaviour therapies for the treatment of eating disorders：a systematic review[J]. Clin Psychol Rev，2017,58:125-140. DOI：10.1016/j.cpr.2017.10.005.
[26]	张靖，陈珏. 辩证行为疗法在进食障碍中的应用[J]. 精神医学杂志，2018,31(4):312-315. DOI：10.3969/j.issn.2095-9346.2018.04.020.
[27]	陈珏. 辩证行为治疗简介[J]. 心理学通讯，2018,1(2):137-140.
[28]	NAVARRO-HARO M V, BOTELLA C, GUILLEN V，et al. Dialectical behavior therapy in the treatment of borderline personality disorder and eating disorders comorbidity：a pilot study in a naturalistic setting[J]. Cogn Ther Res，2018,42(5):636-649. DOI：10.1007/s10608-018-9906-9.
[29]	STEINERT C, MUNDER T, RABUNG S，et al. Psychodynamic therapy：as efficacious as other empirically supported treatments? A meta-analysis testing equivalence of outcomes[J]. Am J Psychiatry，2017,174(10):943-953. DOI：10.1176/appi.ajp.2017.17010057.
[30]	Fluoxetine Bulimia Nervosa Collaborative Study Group. Fluoxetine in the treatment of bulimia nervosa. A multicenter，placebo-controlled，double-blind trial[J]. Arch Gen Psychiatry，1992,49(2):139-147.
[31]	GOLDSTEIN D, WILSON M G, THOMPSON V，et al. Long-term fluoxetine treatment of bulimia nervosa[J]. Br J Psychiatry，1995,166:660-666. DOI：10.1192/bjp.166.5.660.
[32]	GOLDBLOOM D S, OLMSTED M P. Pharmacotherapy of bulimia nervosa with fluoxetine：assessment of clinically significant attitudinal change[J]. Am J Psychiatry，1993,150(5):770-774. DOI：10.1176/ajp.150.5.770.
[33]	HIMMERICH H, KAN C, AU K，et al. Pharmacological treatment of eating disorders，comorbid mental health problems，malnutrition and physical health consequences[J]. Pharmacol Ther，2021,217:107667. DOI：10.1016/j.pharmthera.2020.107667.
[34]	MILANO W, DE ROSA M, MILANO L，et al. A comparative study between three different SSRIs in the treatment of bulimia nervosa[J]. Curr Neurobiol，2013,4(1/2):39-42.
[35]	POPE H G Jr, HUDSON J I, JONAS J M，et al. Bulimia treated with imipramine：a placebo-controlled，double-blind study[J]. Am J Psychiatry，1983,140(5):554-558. DOI：10.1176/ajp.140.5.554.
[36]	MITCHELL J E, GROAT R. A placebo-controlled，double-blind trial of amitriptyline in bulimia[J]. J Clin Psychopharmacol，1984,4(4):186-193.
[37]	HUGHES P L, WELLS L A, CUNNINGHAM C J，et al. Treating bulimia with desipramine. A double-blind，placebo-controlled study[J]. Arch Gen Psychiatry，1986,43(2):182-186. DOI：10.1001/archpsyc.1986.01800020092012.
[38]	BARLOW J, BLOUIN J, BLOUIN A，et al. Treatment of bulimia with desipramine：a double-blind crossover study[J]. Can J Psychiatry，1988,33(2):129-133. DOI：10.1177/070674378803300211.
[39]	BLOUIN A G, BLOUIN J H, PEREZ E L，et al. Treatment of bulimia with fenfluramine and desipramine[J]. J Clin Psychopharmacol，1988,8(4):261-269.
[40]	WALSH B T, HADIGAN C M, DEVLIN M J，et al. Long-term outcome of antidepressant treatment for bulimia nervosa[J]. Am J Psychiatry，1991,148(9):1206-1212. DOI：10.1176/ajp.148.9.1206.
[41]	HUDSON J I, POPE H G Jr, KECK P E Jr，et al. Treatment of bulimia nervosa with trazodone：short-term response and long-term follow-up[J]. Clin Neuropharmacol，1989,12(Suppl 1):S38-S46;DiscussionS47-9. DOI：10.1097/00002826-198901001-00007.
[42]	HORNE R L, FERGUSON J M, POPE H G Jr，et al. Treatment of bulimia with bupropion：a multicenter controlled trial[J]. J Clin Psychiatry，1988,49(7):262-266.
[43]	MCELROY S L, GUERDJIKOVA A I, MORI N，et al. Progress in developing pharmacologic agents to treat bulimia nervosa[J]. CNS Drugs，2019,33(1):31-46. DOI：10.1007/s40263-018-0594-5.
[44]	FARIS P L, KIM S W, MELLER W H，et al. Effect of decreasing afferent vagal activity with ondansetron on symptoms of bulimia nervosa：a randomised，double-blind trial[J]. Lancet，2000,355(9206):792-797. DOI：10.1016/S0140-6736(99)09062-5.
[45]	ULFVEBRAND S, BIRGEGÅRD A, NORRING C，et al. Psychiatric comorbidity in women and men with eating disorders results from a large clinical database[J]. Psychiatry Res，2015,230(2):294-299. DOI：10.1016/j.psychres.2015.09.008.
[46]	LEOMBRUNI P, AMIANTO F, DELSEDIME N，et al. Citalopram versus fluoxetine for the treatment of patients with bulimia nervosa：a single-blind randomized controlled trial[J]. Adv Ther，2006,23(3):481-494. DOI：10.1007/BF02850170.
[47]	BAUER M, SEVERUS E, MÖLLER H J，et al. Pharmacological treatment of unipolar depressive disorders：summary of WFSBP guidelines[J]. Int J Psychiatry Clin Pract，2017,21(3):166-176. DOI：10.1080/13651501.2017.1306082.
[48]	CAMPOS R N, DOS SANTOS D J, CORDÁS T A，et al. Occurrence of bipolar spectrum disorder and comorbidities in women with eating disorders[J]. Int J Bipolar Disord，2013,1:25. DOI：10.1186/2194-7511-1-25.
[49]	MCAULAY C, HAY P, MOND J，et al. Eating disorders，bipolar disorders and other mood disorders：complex and under-researched relationships[J]. J Eat Disord，2019,7:32. DOI：10.1186/s40337-019-0262-2.
[50]	GOODWIN G M, HADDAD P M, FERRIER I N，et al. Evidence-based guidelines for treating bipolar disorder：revised third edition recommendations from the British Association for Psychopharmacology[J]. J Psychopharmacol，2016,30(6):495-553. DOI：10.1177/0269881116636545.
[51]	HAUSSMANN R, LEWITZKA U, SEVERUS E，et al. Correct treatment of mood disorders with lithium[J]. Nervenarzt，2017,88(11):1323-1334. DOI：10.1007/s00115-017-0421-0.
[52]	JACOBSON S J, JONES K, JOHNSON K，et al. Prospective multicentre study of pregnancy outcome after lithium exposure during first trimester[J]. Lancet，1992,339(8792):530-533. DOI：10.1016/0140-6736(92)90346-5.
[53]	REILLY E E, BERNER L A, TRUNKO M E，et al. Evaluating the use of lamotrigine to reduce mood lability and impulsive behaviors in adults with chronic and severe eating disorders[J]. Eat Weight Disord，2022,27(5):1775-1785. DOI：10.1007/s40519-021-01320-3.
[54]	GUERDJIKOVA A I, MCELROY S L. Adjunctive methylphenidate in the treatment of bulimia nervosa co-occurring with bipolar disorder and substance dependence[J]. Innov Clin Neurosci，2013,10(2):30-33.
[55]	BERNER L A, REILLY E E, YU X Z，et al. Changes in cognitive and behavioral control after lamotrigine and intensive dialectical behavioral therapy for severe，multi-impulsive bulimia nervosa：an fMRI case study[J]. Eat Weight Disord，2022,27(5):1919-1928. DOI：10.1007/s40519-021-01308-z.
[56]	GOODWIN G M, HADDAD P M, FERRIER I N，et al. Evidence-based guidelines for treating bipolar disorder：revised third edition recommendations from the British Association for Psychopharmacology[J]. J Psychopharmacol，2016,30(6):495-553. DOI：10.1177/0269881116636545.
[57]	BALDWIN D S, WALDMAN S, ALLGULANDER C. Evidence-based pharmacological treatment of generalized anxiety disorder[J]. Int J Neuropsychopharmacol，2011,14(5):697-710. DOI：10.1017/S1461145710001434.
[58]	DELL'OSSO B, LADER M. Do benzodiazepines still deserve a major role in the treatment of psychiatric disorders? A critical reappraisal[J]. Eur Psychiatry，2013,28(1):7-20. DOI：10.1016/j.eurpsy.2011.11.003.
[59]	GRAVINA G, MILANO W, NEBBIAI G，et al. Medical complications in anorexia and bulimia nervosa[J]. Endocr Metab Immune Disord Drug Targets，2018,18(5):477-488. DOI：10.2174/1871530318666180531094508.
[60]	HIMMERICH H, BENTLEY J, LICHTBLAU N，et al. Facets of shared decision-making on drug treatment for adults with an eating disorder[J]. Int Rev Psychiatry，2019,31(4):332-346. DOI：10.1080/09540261.2019.1571995.
[61]	MÜLLER-LISSNER S A. Adverse effects of laxatives：fact and fiction[J]. Pharmacology，1993,47(Suppl 1):138-145. DOI：10.1159/000139853.
[62]	HUDSON J I, HIRIPI E, POPE H G Jr，et al. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication[J]. Biol Psychiatry，2007,61(3):348-358. DOI：10.1016/j.biopsych.2006.03.040.
[63]	WOODSIDE D B, GARFINKEL P E, LIN E，et al. Comparisons of men with full or partial eating disorders，men without eating disorders，and women with eating disorders in the community[J]. Am J Psychiatry，2001,158(4):570-574. DOI：10.1176/appi.ajp.158.4.570.
[64]	ALLEN K L, BYRNE S M, ODDY W H，et al. Early onset binge eating and purging eating disorders：course and outcome in a population-based study of adolescents[J]. J Abnorm Child Psychol，2013,41(7):1083-1096. DOI：10.1007/s10802-013-9747-7.
[65]	KJELSÅS E, BJØRNSTRØM C, GÖTESTAM K G. Prevalence of eating disorders in female and male adolescents （14-15 years）[J]. Eat Behav，2004,5(1):13-25. DOI：10.1016/S1471-0153(03)00057-6.
[66]	GORRELL S, MURRAY S B. Eating disorders in males[J]. Child Adolesc Psychiatr Clin N Am，2019,28(4):641-651. DOI：10.1016/j.chc.2019.05.012.
[67]	EASTER A, SOLMI F, BYE A，et al. Antenatal and postnatal psychopathology among women with current and past eating disorders：longitudinal patterns[J]. Eur Eat Disord Rev，2015,23(1):19-27. DOI：10.1002/erv.2328.
[68]	PHILIP N S, NELSON B G, FROHLICH F，et al. Low-intensity transcranial current stimulation in psychiatry[J]. Am J Psychiatry，2017,174(7):628-639. DOI：10.1176/appi.ajp.2017.16090996.
[69]	VAN DEN EYNDE F, BROADBENT H, GUILLAUME S，et al. Handedness，repetitive transcranial magnetic stimulation and bulimic disorders[J]. Eur Psychiatry，2012,27(4):290-293. DOI：10.1016/j.eurpsy.2010.08.015.
[70]	GAY A, JAUSSENT I, SIGAUD T，et al. A lack of clinical effect of high-frequency rTMS to dorsolateral prefrontal cortex on bulimic symptoms：a randomised，double-blind trial[J]. Eur Eat Disord Rev，2016,24(6):474-481. DOI：10.1002/erv.2475.
[71]	GUILLAUME S, GAY A, JAUSSENT I，et al. Improving decision-making and cognitive impulse control in bulimia nervosa by rTMS：an ancillary randomized controlled study[J]. Int J Eat Disord，2018,51(9):1103-1106. DOI：10.1002/eat.22942.
[72]	陈妍，陈珏. 神经调控技术在进食障碍中的应用[J]. 中华行为医学与脑科学杂志，2021,30(5):469-475. DOI：10.3760/cma.j.cn371468-20210104-00019.

推荐强度	证据级别（级）	病因、治疗、预防
A	1a	多个同质随机对照研究的系统综述
	1b	单个随机对照研究
	1c	"全或无"证据
B	2a	同质性队列研究的系统综述
	2b	单一的队列研究（包括低质量的随机对照研究，如随访率<80%）
	2c	结局性研究
	3a	同质性病例对照研究的系统综述
	3b	单独的病例对照研究
C	4	病例系列
D	5	没有严格评价的专家意见，或完全基于生理学和基础研究

推荐强度	证据级别（级）	病因、治疗、预防
A	1a	多个同质随机对照研究的系统综述
	1b	单个随机对照研究
	1c	"全或无"证据
B	2a	同质性队列研究的系统综述
	2b	单一的队列研究（包括低质量的随机对照研究，如随访率<80%）
	2c	结局性研究
	3a	同质性病例对照研究的系统综述
	3b	单独的病例对照研究
C	4	病例系列
D	5	没有严格评价的专家意见，或完全基于生理学和基础研究

项目	治疗目标	适应人群	推荐疗程	推荐强度/证据级别
CBT	打破暴食-清除恶性循环，控制BN症状，降低对自身体质量和体形的过度关注	青少年、成人BN	4~6个月，约20次访谈	A/1a
IPT	聚焦于识别和改变导致进食问题发生、发展和持续的人际关系背景	成人BN	4~5个月，15~20次访谈	B/1b
DBT	帮助患者认识自我、学会调节情绪、建立良好的人际关系以及学会承受生活中不可避免的痛苦，从而减少暴食和清除行为	成人BN	6个月，20次访谈	B/2a
精神动力性心理治疗	帮助患者理解其症状与早年经历、生活事件之间的关系，理解BN症状背后的潜意识冲突、防御方式等，理解暴食和清除行为的心理意义、在其生活中的作用，患者通过领悟从而调整其行为	成人BN	约1年，50次访谈	B/1b
家庭治疗	通过维系家庭平衡，减少暴食清除频率	青少年BN	6个月，20次访谈	A/1a

项目	治疗目标	适应人群	推荐疗程	推荐强度/证据级别
CBT	打破暴食-清除恶性循环，控制BN症状，降低对自身体质量和体形的过度关注	青少年、成人BN	4~6个月，约20次访谈	A/1a
IPT	聚焦于识别和改变导致进食问题发生、发展和持续的人际关系背景	成人BN	4~5个月，15~20次访谈	B/1b
DBT	帮助患者认识自我、学会调节情绪、建立良好的人际关系以及学会承受生活中不可避免的痛苦，从而减少暴食和清除行为	成人BN	6个月，20次访谈	B/2a
精神动力性心理治疗	帮助患者理解其症状与早年经历、生活事件之间的关系，理解BN症状背后的潜意识冲突、防御方式等，理解暴食和清除行为的心理意义、在其生活中的作用，患者通过领悟从而调整其行为	成人BN	约1年，50次访谈	B/1b
家庭治疗	通过维系家庭平衡，减少暴食清除频率	青少年BN	6个月，20次访谈	A/1a

中国神经性贪食诊疗专家共识

Chinese Expert Consensus on the Diagnosis and Treatment of Bulimia Nervosa

RichHTML

PDF

可视化

摘要/Abstract

引用本文

使用本文

图/表 2

参考文献 72

相关文章 15

编辑推荐

Metrics

留言

[1]	马弘阳, 岳岸娜, 孙康云. 家族性高胆固醇血症国内外诊疗异同[J]. 中国全科医学, 2025, 28(06): 655-665.
[2]	方湘, 宋海齐, 廖晓阳, 刘力滴, 张鹏, 贾禹, 杨梓钰, 杨荣, 刘如辉. 中国妊娠期高血压疾病的管理建议：基于《2023年澳大利亚和新西兰产科医学协会妊娠期高血压疾病指南摘要》[J]. 中国全科医学, 2025, 28(06): 649-654.
[3]	倪小佳, 林浩, 罗旭飞, 邝卓然, 刘云兰, 郭建文, 陈耀龙, 蔡业峰, 脑卒中中西医结合防治指南工作组. 脑卒中中西医结合防治指南（2023版）[J]. 中国全科医学, 2025, 28(05): 521-533.
[4]	罗原, 徐志杰, 夏瑀, 石佳娜, 蒋志志, 周馨媚, 赵洋, 童钰铃. 共病药物治疗决策——全科医生接诊病案研究[J]. 中国全科医学, 2025, 28(01): 119-124.
[5]	周馨媚, 韩利艳, 夏瑀, 李海昕, 罗原, 钱熠, 赵洋, 徐志杰. 社区全科医生慢性病共病药物治疗决策能力提升培训需求的定性研究[J]. 中国全科医学, 2025, 28(01): 111-118.
[6]	夏瑀, 罗原, 李峥嵘, 周馨媚, 童钰铃, 赵洋, 徐志杰. 社区慢性病共病药物治疗决策的困境与应对路径[J]. 中国全科医学, 2025, 28(01): 103-110.
[7]	彭涛, 邹川, 曾欣, 张焱, 沈静. 基于卡尔加里-剑桥指南的沙龙培训模式提升全科规培医师医患沟通技能的对照研究[J]. 中国全科医学, 2025, 28(01): 71-76.
[8]	陈鹏飞, 刘雅茜, 王途之, 张桂梅, 蔡艺娴, 潘集阳. 失眠的在线简版行为疗法对失眠障碍的干预效果研究[J]. 中国全科医学, 2024, 27(35): 4370-4375.
[9]	秦晓宽, 孙凯, 冯天笑, 肖想玉, 王国辰, 苏祥飞, 魏戌, 朱立国. 腰椎间盘突出症临床实践指南和专家共识的方法学质量评价与综合分析[J]. 中国全科医学, 2024, 27(31): 3857-3864.
[10]	中国老年医学学会睡眠医学分会. 老年阻塞性睡眠呼吸暂停患者无创正压通气应用规范专家共识[J]. 中国全科医学, 2024, 27(31): 3841-3849.
[11]	冯天笑, 孙凯, 秦晓宽, 王旭, 卜寒梅, 朱立国, 魏戌. 中医骨伤科临床实践指南的发展：现状、挑战及策略[J]. 中国全科医学, 2024, 27(31): 3850-3856.
[12]	国家老年医学中心, 中华医学会糖尿病学分会, 中国体育科学学会. 中国2型糖尿病运动治疗指南（2024版）[J]. 中国全科医学, 2024, 27(30): 3709-3738.
[13]	张雅思, 张静, 徐晨, 孙玉静, 白银洁. 基于COSMIN指南对癌症患者心理弹性评估工具的系统评价[J]. 中国全科医学, 2024, 27(29): 3664-3671.
[14]	张鹏, 刘力滴, 杨梓钰, 杨荣, 吕垚, 周伊恒, 方湘, 雷弋, 代华, 廖晓阳. 2023年美国预防临床服务指南工作组《妊娠期高血压疾病筛查》推荐声明解读[J]. 中国全科医学, 2024, 27(29): 3581-3586.
[15]	李胜含, 杜和越, 安康, 何龙韬, 李静, 李舍予. 心血管疾病一级和二级预防患者用药习惯的价值观与偏好：一项探索式混合方法研究[J]. 中国全科医学, 2024, 27(27): 3336-3343.