中国暴食障碍诊疗专家共识

doi:10.12114/j.issn.1007-9572.2024.0030

中国全科医学 ›› 2024, Vol. 27 ›› Issue (24): 2941-2953.DOI: 10.12114/j.issn.1007-9572.2024.0030

• 指南·共识 • 下一篇

中国暴食障碍诊疗专家共识

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, 彭素芳¹, 何欠欠², 刘强¹, 陈妍¹, 张岚³, 李雪霓⁴, 乔慧芬⁵, 孔庆梅⁴, 匡桂芳⁶, 陈涵¹, 虞阳⁷, 蒋晶晶⁸, 刘兰英¹, 张大荣⁴, 栗克清⁹, 王振¹, 陈珏^*()

1．200030　上海市，上海交通大学医学院附属精神卫生中心
2．200120　上海市，同济大学附属精神卫生中心（筹）
3．610041　四川省成都市，四川大学华西医院心理卫生中心
4．100091　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）
5．210029　江苏省南京市，南京医科大学附属脑科医院
6．266034　山东省青岛市，青岛大学附属妇女儿童医院
7．200040　上海市，复旦大学附属华东医院
8．200030　上海市，复旦大学附属中山医院
9．071000　河北省保定市，河北省精神卫生中心

收稿日期:2024-03-05 修回日期:2024-04-20 出版日期:2024-08-20 发布日期:2024-05-08
通讯作者: 陈珏
基金资助:
国家自然科学基金面上项目(820715451); 上海市卫生健康委员会面上项目(202140092); 上海市科学技术委员会医学创新研究专项项目(20Y119065003); 上海市精神心理疾病临床医学研究中心项目(19MC1911100); 上海市精神卫生中心院级重点课题(2020zd02)

Chinese Expert Consensus on the Diagnosis and Treatment of Binge Eating Disorder

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, PENG Sufang¹, HE Qianqian², LIU Qiang¹, CHEN Yan¹, ZHANG Lan³, LI Xueni⁴, QIAO Huifen⁵, KONG Qingmei⁴, KUANG Guifang⁶, CHEN Han¹, YU Yang⁷, JIANG Jingjing⁸, LIU Lanying¹, ZHANG Darong⁴, LI Keqing⁹, WANG Zhen¹, CHEN Jue¹^,^*()

1. Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
2. Mental Health Center of Tongji University, Shanghai 200120, China
3. Mental Health Center, West China Hospital, Sichuan University, Chengdu 610041, China
4. 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
5. Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing 210029, China
6. Women and Children's Hospital, Qingdao University, Qingdao 266034, China
7. Huadong Hospital Affiliated to Fudan University, Shanghai 200040, China
8. Zhongshan Hospital Affiliated to Fudan University, Shanghai 200030, China
9. Hebei Mental Health Center, Baoding 071000, China

Received:2024-03-05 Revised:2024-04-20 Published:2024-08-20 Online:2024-05-08
Contact: CHEN Jue

分享到

摘要/Abstract

摘要： 暴食障碍是以反复发作性暴食为主要特征的一类进食障碍。暴食障碍患者存在反复发作、冲动性、失控性的暴食行为，可导致胃肠道疾病、高血压、肥胖及由此引起的代谢和各系统功能紊乱等躯体问题；也常共病心境障碍、焦虑障碍、物质使用障碍等多种精神障碍，需引起重视。然而，国内对暴食障碍的认识较晚，目前难以做到早期识别和诊治，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15名精神科专家及循证医学专家，2名内科专家组成《中国暴食障碍诊疗专家共识》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、内科医师和全科医师对暴食障碍的识别和诊治水平。

关键词: 暴食症, 饮食与进食障碍, 心理治疗, 药物治疗, 专家共识

Abstract:

Binge-eating disorder (BED) is a type of eating disorder characterized by recurrent episodes of binge eating. Patients with BED have recurrent impulsive and out-of-controlled binge eating behavior, which can lead to gastrointestinal disorders, obesity, and the resulting metabolic and functional disorders of various systems and other physical problems; and it is also often co-morbid with affective disorder, anxiety disorders, substance use disorders, and other mental disorders, which need to be taken seriously. However, the recognition of BED in China was late, and it is difficult to achieve early identification and diagnosis, resulting in a prolonged course of disease. Therefore, under the organization of the Eating Disorders Coordination Group of the Psychosomatic Medicine Society of the Chinese Medical Association, together with the Eating Disorders Research Collaboration Group of the Psychiatric Medicine Society of the Chinese Medical Association, an expert group composed of 15 psychiatrists and evidence-based medicine experts, and 2 internal medicine experts, formulated this expert consensus based on evidence-based medical evidence, domestic and foreign guidelines and expert consensus, and expert experiences. The aim of this study is to improve the recognition, diagnosis and treatment of BED by psychiatrists, internists and general practitioners in China.

Key words: Binge-eating disorder, Feeding and eating disorders, Psychological treatment, Drug therapy, Expert consensus

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,彭素芳,等. 中国暴食障碍诊疗专家共识[J]. 中国全科医学, 2024, 27(24): 2941-2953. DOI: 10.12114/j.issn.1007-9572.2024.0030.
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,PENG Sufang, et al. Chinese Expert Consensus on the Diagnosis and Treatment of Binge Eating Disorder[J]. Chinese General Practice, 2024, 27(24): 2941-2953. DOI: 10.12114/j.issn.1007-9572.2024.0030.

图/表 2

参考文献 95

[1]	陈珏. 进食障碍[M]. 北京：人民卫生出版社，2013.
[2]	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.
[3]	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.
[4]	GLAZER K B，SONNEVILLE K R，MICALI N，et al. The course of eating disorders involving bingeing and purging among adolescent girls：prevalence，stability，and transitions[J]. J Adolesc Health，2019，64（2）：165-171. DOI：10.1016/j.jadohealth.2018.09.023.
[5]	ERSKINE H E，WHITEFORD H A. Epidemiology of binge eating disorder[J]. Curr Opin Psychiatry，2018，31（6）：462-470. DOI：10.1097/YCO.0000000000000449.
[6]	FICHTER M M，QUADFLIEG N. Mortality in eating disorders - results of a large prospective clinical longitudinal study[J]. Int J Eat Disord，2016，49（4）：391-401. DOI：10.1002/eat.22501.
[7]	UDO T，GRILO C M. Prevalence and correlates of DSM-5-defined eating disorders in a nationally representative sample of U.S. adults[J]. Biol Psychiatry，2018，84（5）：345-354. DOI：10.1016/j.biopsych.2018.03.014.
[8]	UDO T，GRILO C M. Psychiatric and medical correlates of DSM-5 eating disorders in a nationally representative sample of adults in the United States[J]. Int J Eat Disord，2019，52（1）：42-50. DOI：10.1002/eat.23004.
[9]	GIEL K E，BULIK C M，FERNANDEZ-ARANDA F，et al. Binge eating disorder[J]. Nat Rev Dis Primers，2022，8：16. DOI：10.1038/s41572-022-00344-y.
[10]	PARKER K，BRENNAN L. Measurement of disordered eating in bariatric surgery candidates：a systematic review of the literature[J]. Obes Res Clin Pract，2015，9（1）：12-25. DOI：10.1016/j.orcp.2014.01.005.
[11]	National Institute for Health and Care Excellence （NICE）. Eating Disorders：recognition and treatment Eating disorders[M]. London：National Institute for Health and Care Excellence （NICE），2020：1-69.
[12]	LOCK J，LA VIA M C. 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.
[13]	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.
[14]	HILBERT A. Binge-eating disorder[J]. Psychiatr Clin N Am，2019，42（1）：33-43. DOI：10.1016/j.psc.2018.10.011.
[15]	HILBERT A，PETROFF D，HERPERTZ S，et al. Meta-analysis of the efficacy of psychological and medical treatments for binge-eating disorder[J]. J Consult Clin Psychol，2019，87（1）：91-105. DOI：10.1037/ccp0000358.
[16]	LINARDON J，WADE T D，DE LA PIEDAD GARCIA X，et al. The efficacy of cognitive-behavioral therapy for eating disorders：a systematic review and meta-analysis[J]. J Consult Clin Psychol，2017，85（11）：1080-1094. DOI：10.1037/ccp0000245.
[17]	DE ZWAAN M，HERPERTZ S，ZIPFEL S，et al. Effect of internet-based guided self-help vs individual face-to-face treatment on full or subsyndromal binge eating disorder in overweight or obese patients：the INTERBED randomized clinical trial[J]. JAMA Psychiatry，2017，74（10）：987-995. DOI：10.1001/jamapsychiatry.2017.2150.
[18]	DINGEMANS A，DANNER U，PARKS M. Emotion regulation in binge eating disorder：a review[J]. Nutrients，2017，9（11）：1274. DOI：10.3390/nu9111274.
[19]	CHEN E Y，MATTHEWS L，ALLEN C，et al. Dialectical behavior therapy for clients with binge-eating disorder or bulimia nervosa and borderline personality disorder[J]. Int J Eat Disord，2008，41（6）：505-512. DOI：10.1002/eat.20522.
[20]	GHADERI A，ODEBERG J，GUSTAFSSON S，et al. Psychological，pharmacological，and combined treatments for binge eating disorder：a systematic review and meta-analysis[J]. PeerJ，2018，6：e5113. DOI：10.7717/peerj.5113.
[21]	HILBERT A，BISHOP M E，STEIN R I，et al. Long-term efficacy of psychological treatments for binge eating disorder[J]. Br J Psychiatry，2012，200（3）：232-237. DOI：10.1192/bjp.bp.110.089664.
[22]	WILSON G T，WILFLEY D E，AGRAS W S，et al. Psychological treatments of binge eating disorder[J]. Arch Gen Psychiatry，2010，67（1）：94-101. DOI：10.1001/archgenpsychiatry.2009.170.
[23]	KRISTELLER J L，HALLETT C B. An exploratory study of a meditation-based intervention for binge eating disorder[J]. J Health Psychol，1999，4（3）：357-363. DOI：10.1177/135910539900400305.
[24]	KRISTELLER J L，WOLEVER R Q. Mindfulness-based eating awareness training for treating binge eating disorder：the conceptual foundation[J]. Eat Disord，2011，19（1）：49-61. DOI：10.1080/10640266.2011.533605.
[25]	JENSEN M D，RYAN D H，APOVIAN C M，et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults：a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Obesity Society[J]. Circulation，2014，129（25 Suppl 2）：S102-138. DOI：10.1161/01.cir.0000437739.71477.ee.
[26]	PALAVRAS M A，HAY P，FILHO C A，et al. The efficacy of psychological therapies in reducing weight and binge eating in people with bulimia nervosa and binge eating disorder who are overweight or obese-a critical synthesis and meta-analyses[J]. Nutrients，2017，9（3）：299. DOI：10.3390/nu9030299.
[27]	GRILO C M，LYDECKER J A，FINEBERG S K，et al. Naltrexone-bupropion and behavior therapy，alone and combined，for binge-eating disorder：randomized double-blind placebo-controlled trial[J]. Am J Psychiatry，2022，179（12）：927-937. DOI：10.1176/appi.ajp.20220267.
[28]	GRILO C M，JUARASCIO A. Binge-eating disorder interventions：review，current status，and implications[J]. Curr Obes Rep，2023，12（3）：406-416. DOI：10.1007/s13679-023-00517-0.
[29]	HILBERT A，PETROFF D，HERPERTZ S，et al. Meta-analysis on the long-term effectiveness of psychological and medical treatments for binge-eating disorder[J]. Int J Eat Disord，2020，53（9）：1353-1376. DOI：10.1002/eat.23297.
[30]	GRILO C M，REAS D L，MITCHELL J E. Combining pharmacological and psychological treatments for binge eating disorder：current status，limitations，and future directions[J]. Curr Psychiatry Rep，2016，18（6）：55. DOI：10.1007/s11920-016-0696-z.
[31]	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.
[32]	CRONE C，FOCHTMANN L J，ATTIA E，et al. The American psychiatric association practice guideline for the treatment of patients with eating disorders[J]. Am J Psychiatry，2023，180（2）：167-171. DOI：10.1176/appi.ajp.23180001.
[33]	National Collaborating Centre for Mental Health（UK）. Eating disorders：core interventions in the treatment and management of anorexia nervosa，bulimia nervosa and related eating disorders[J]. British Psychological Dociety，2004.
[34]	MALHOTRA S，KING K H，WELGE J A，et al. Venlafaxine treatment of binge-eating disorder associated with obesity：a series of 35 patients[J]. J Clin Psychiatry，2002，63（9）：802-806. DOI：10.4088/jcp.v63n0909.
[35]	GUERDJIKOVA A I，MCELROY S L，WINSTANLEY E L，et al. Duloxetine in the treatment of binge eating disorder with depressive disorders：a placebo-controlled trial[J]. Int J Eat Disord，2012，45（2）：281-289. DOI：10.1002/eat.20946.
[36]	FORNARO M，SOLMI M，PERNA G，et al. Lisdexamfetamine in the treatment of moderate-to-severe binge eating disorder in adults：systematic review and exploratory meta-analysis of publicly available placebo-controlled，randomized clinical trials[J]. Neuropsychiatr Dis Treat，2016，12：1827-1836. DOI：10.2147/NDT.S109637.
[37]	CORWIN R L，BOAN J，PETERS K F，et al. Baclofen reduces binge eating in a double-blind，placebo-controlled，crossover study[J]. Behav Pharmacol，2012，23（5/6）：616-625. DOI：10.1097/FBP.0b013e328357bd62.
[38]	NOURREDINE M，JUREK L，AUFFRET M，et al. Efficacy and safety of topiramate in binge eating disorder：a systematic review and meta-analysis[J]. CNS Spectr，2021，26（5）：459-467. DOI：10.1017/S1092852920001613.
[39]	REAS D L，GRILO C M. Psychotherapy and medications for eating disorders：better together?[J]. Clin Ther，2021，43（1）：17-39. DOI：10.1016/j.clinthera.2020.10.006.
[40]	MCELROY S L，HUDSON J I，GRILO C M，et al. Efficacy and safety of dasotraline in adults with binge-eating disorder：a randomized，placebo-controlled，flexible-dose clinical trial[J]. J Clin Psychiatry，2020，81（5）：19m13068. DOI：10.4088/JCP.19m13068.
[41]	GRILO C M，MCELROY S L，HUDSON J I，et al. Efficacy and safety of dasotraline in adults with binge-eating disorder：a randomized，placebo-controlled，fixed-dose clinical trial[J]. CNS Spectr，2021，26（5）：481-490. DOI：10.1017/S1092852920001406.
[42]	GRUNZE H，VIETA E，GOODWIN G M，et al. The World Federation of Societies of Biological Psychiatry（WFSBP） guidelines for the biological treatment of bipolar disorders：update 2012 on the long-term treatment of bipolar disorder[J]. World J Biol Psychiatry，2013，14（3）：154-219. DOI：10.3109/15622975.2013.770551.
[43]	MCELROY S L，GUERDJIKOVA A，KOTWAL R，et al. Atomoxetine in the treatment of binge-eating disorder：a randomized placebo-controlled trial[J]. J Clin Psychiatry，2007，68（3）：390-398. DOI：10.4088/jcp.v68n0306.
[44]	SCHAG K，RENNHAK S K，LEEHR E J，et al. IMPULS：impulsivity-focused group intervention to reduce binge eating episodes in patients with binge eating disorder - A randomised controlled trial[J]. Psychother Psychosom，2019，88（3）：141-153. DOI：10.1159/000499696.
[45]	PREUSS H，PINNOW M，SCHNICKER K，et al. Improving inhibitory control abilities （ImpulsE）-a promising approach to treat impulsive eating?[J]. Eur Eat Disord Rev，2017，25（6）：533-543. DOI：10.1002/erv.2544.
[46]	GIEL K E，TEUFEL M，JUNNE F，et al. Food-related impulsivity in obesity and binge eating disorder-a systematic update of the evidence[J]. Nutrients，2017，9（11）：1170. DOI：10.3390/nu9111170.
[47]	RAMAN J，HAY P，TCHANTURIA K，et al. A randomised controlled trial of manualized cognitive remediation therapy in adult obesity[J]. Appetite，2018，123：269-279. DOI：10.1016/j.appet.2017.12.023.
[48]	İNCE B，SCHLATTER J，MAX S，et al. Can we change binge eating behaviour by interventions addressing food-related impulsivity? A systematic review[J]. J Eat Disord，2021，9（1）：38. DOI：10.1186/s40337-021-00384-x.
[49]	EICHEN D M，MATHESON B E，APPLETON-KNAPP S L，et al. Neurocognitive treatments for eating disorders and obesity[J]. Curr Psychiatry Rep，2017，19（9）：62. DOI：10.1007/s11920-017-0813-7.
[50]	CHAMI R，CARDI V，LAWRENCE N，et al. Targeting binge eating in bulimia nervosa and binge eating disorder using inhibitory control training and implementation intentions：a feasibility trial[J]. Psychol Med，2022，52（5）：874-883. DOI：10.1017/S0033291720002494.
[51]	BROCKMEYER T，FRIEDERICH H C，KÜPPERS C，et al. Approach bias modification training in bulimia nervosa and binge-eating disorder：a pilot randomized controlled trial[J]. Int J Eat Disord，2019，52（5）：520-529. DOI：10.1002/eat.23024.
[52]	GIEL K E，SPEER E，SCHAG K，et al. Effects of a food-specific inhibition training in individuals with binge eating disorder-findings from a randomized controlled proof-of-concept study[J]. Eat Weight Disord，2017，22（2）：345-351. DOI：10.1007/s40519-017-0371-3.
[53]	LEWER M，KOSFELDER J，MICHALAK J，et al. Effects of a cognitive-behavioral exposure-based body image therapy for overweight females with binge eating disorder：a pilot study[J]. J Eat Disord，2017，5：43. DOI：10.1186/s40337-017-0174-y.
[54]	SCHYNS G，VAN DEN AKKER K，ROEFS A，et al. Exposure therapy vs lifestyle intervention to reduce food cue reactivity and binge eating in obesity：a pilot study[J]. J Behav Ther Exp Psychiatry，2020，67：101453. DOI：10.1016/j.jbtep.2019.01.005.
[55]	MANZONI G M，CESA G L，BACCHETTA M，et al. Virtual reality-enhanced cognitive-behavioral therapy for morbid obesity：a randomized controlled study with 1 year follow-up[J]. Cyberpsychol Behav Soc Netw，2016，19（2）：134-140. DOI：10.1089/cyber.2015.0208.
[56]	RUNFOLA C D，KIRBY J S，BAUCOM D H，et al. A pilot open trial of UNITE-BED：a couple-based intervention for binge-eating disorder[J]. Int J Eat Disord，2018，51（9）：1107-1112. DOI：10.1002/eat.22919.
[57]	DALTON B，CAMPBELL I C，SCHMIDT U. Neuromodulation and neurofeedback treatments in eating disorders and obesity[J]. Curr Opin Psychiatry，2017，30（6）：458-473. DOI：10.1097/YCO.0000000000000361.
[58]	DALTON B，BARTHOLDY S，CAMPBELL I C，et al. Neurostimulation in clinical and sub-clinical eating disorders：a systematic update of the literature[J]. Curr Neuropharmacol，2018，16（8）：1174-1192. DOI：10.2174/1570159X16666180108111532.
[59]	ZENG B Y，ZENG B S，CHEN Y W，et al. Efficacy and acceptability of noninvasive brain stimulation interventions for weight reduction in obesity：a pilot network meta-analysis[J]. Int J Obes，2021，45（8）：1705-1716. DOI：10.1038/s41366-021-00833-2.
[60]	SHIVACHARAN R S，ROLLE C E，BARBOSA D A N，et al. Pilot study of responsive nucleus accumbens deep brain stimulation for loss-of-control eating[J]. Nat Med，2022，28（9）：1791-1796. DOI：10.1038/s41591-022-01941-w.
[61]	MAX S M，PLEWNIA C，ZIPFEL S，et al. Combined antisaccade task and transcranial direct current stimulation to increase response inhibition in binge eating disorder[J]. Eur Arch Psychiatry Clin Neurosci，2021，271（1）：17-28. DOI：10.1007/s00406-020-01164-5.
[62]	GORDON G，BROCKMEYER T，SCHMIDT U，et al. Combining cognitive bias modification training （CBM） and transcranial direct current stimulation （tDCS） to treat binge eating disorder：study protocol of a randomised controlled feasibility trial[J]. BMJ Open，2019，9（10）：e030023. DOI：10.1136/bmjopen-2019-030023.
[63]	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.
[64]	BECKER D F，GRILO C M. Comorbidity of mood and substance use disorders in patients with binge-eating disorder：associations with personality disorder and eating disorder pathology[J]. J Psychosom Res，2015，79（2）：159-164. DOI：10.1016/j.jpsychores.2015.01.016.
[65]	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.
[66]	CALANDRA C，RUSSO R G，LUCA M. Bupropion versus sertraline in the treatment of depressive patients with binge eating disorder：retrospective cohort study[J]. Psychiatr Q，2012，83（2）：177-185. DOI：10.1007/s11126-011-9192-0.
[67]	HALSETH A，SHAN K，GILDER K，et al. Quality of life，binge eating and sexual function in participants treated for obesity with sustained release naltrexone/bupropion[J]. Obes Sci Pract，2018，4（2）：141-152. DOI：10.1002/osp4.156.
[68]	GUERDJIKOVA A I，WALSH B，SHAN K，et al. Concurrent improvement in both binge eating and depressive symptoms with naltrexone/bupropion therapy in overweight or obese subjects with major depressive disorder in an open-label，uncontrolled study[J]. Adv Ther，2017，34（10）：2307-2315. DOI：10.1007/s12325-017-0613-9.
[69]	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.
[70]	SCHMIDT DO PRADO-LIMA P A，BACALTCHUCK J. Topiramate in treatment-resistant depression and binge-eating disorder[J]. Bipolar Disord，2002，4（4）：271-273. DOI：10.1034/j.1399-5618.2002.01182.x.
[71]	GORACCI A，DI VOLO S，CASAMASSIMA F，et al. Pharmacotherapy of binge-eating disorder：a review[J]. J Addict Med，2015，9（1）：1-19. DOI：10.1097/ADM.0000000000000089.
[72]	BROFT A I，SPANOS A，CORWIN R L，et al. Baclofen for binge eating：an open-label trial[J]. Int J Eat Disord，2007，40（8）：687-691. DOI：10.1002/eat.20434.
[73]	JONAS J M，GOLD M S. The use of opiate antagonists in treating bulimia：a study of low-dose versus high-dose naltrexone[J]. Psychiatry Res，1988，24（2）：195-199. DOI：10.1016/0165-1781(88)90062-5.
[74]	MCELROY S L，GUERDJIKOVA A I，BLOM T J，et al. A placebo-controlled pilot study of the novel opioid receptor antagonist ALKS-33 in binge eating disorder[J]. Int J Eat Disord，2013，46（3）：239-245. DOI：10.1002/eat.22114.
[75]	MCELROY S L，GUERDJIKOVA A I，WINSTANLEY E L，et al. Acamprosate in the treatment of binge eating disorder：a placebo-controlled trial[J]. Int J Eat Disord，2011，44（1）：81-90. DOI：10.1002/eat.20876.
[76]	HARRIS S R，CARRILLO M，FUJIOKA K. Binge-eating disorder and type 2 diabetes：a review[J]. Endocr Pract，2021，27（2）：158-164. DOI：10.1016/j.eprac.2020.10.005.
[77]	YOUNG-HYMAN D L，DAVIS C L. Disordered eating behavior in individuals with diabetes：importance of context，evaluation，and classification[J]. Diabetes Care，2010，33（3）：683-689. DOI：10.2337/dc08-1077.
[78]	BROWN A，GUESS N，DORNHORST A，et al. Insulin-associated weight gain in obese type 2 diabetes mellitus patients：what can be done?[J]. Diabetes Obes Metab，2017，19（12）：1655-1668. DOI：10.1111/dom.13009.
[79]	WILLIAMS D L. Minireview：finding the sweet spot：peripheral versus central glucagon-like peptide 1 action in feeding and glucose homeostasis[J]. Endocrinology，2009，150（7）：2997-3001. DOI：10.1210/en.2009-0220.
[80]	MCELROY S L，MORI N，GUERDJIKOVA A I，et al. Would glucagon-like peptide-1 receptor agonists have efficacy in binge eating disorder and bulimia nervosa? A review of the current literature[J]. Med Hypotheses，2018，111：90-93. DOI：10.1016/j.mehy.2017.12.029.
[81]	ROBERT S A，ROHANA A G，SHAH S A，et al. Improvement in binge eating in non-diabetic obese individuals after 3 months of treatment with liraglutide— a pilot study[J]. Obes Res Clin Pract，2015，9（3）：301-304. DOI：10.1016/j.orcp.2015.03.005.
[82]	PORTO A D，CASARSA V，COLUSSI G，et al. Dulaglutide reduces binge episodes in type 2 diabetic patients with binge eating disorder：a pilot study[J]. Diabetes Metab Syndr，2020，14（4）：289-292. DOI：10.1016/j.dsx.2020.03.009.
[83]	MARSO S P，BAIN S C，CONSOLI A，et al. Semaglutide and cardiovascular outcomes in patients with type 2 diabetes[J]. N Engl J Med，2016，375（19）：1834-1844. DOI：10.1056/NEJMoa1607141.
[84]	MARSO S P，DANIELS G H，BROWN-FRANDSEN K，et al. Liraglutide and cardiovascular outcomes in type 2 diabetes[J]. N Engl J Med，2016，375（4）：311-322. DOI：10.1056/NEJMoa1603827.
[85]	VAN DYCK Z，SCHULZ A，BLECHERT J，et al. Gastric interoception and gastric myoelectrical activity in bulimia nervosa and binge-eating disorder[J]. Int J Eat Disord，2021，54（7）：1106-1115. DOI：10.1002/eat.23291.
[86]	ACHAMRAH N，GRIGIONI S，COËFFIER M，et al. Gastric necrosis after binge eating in bulimia：recovery from eating disorder after total gastrectomy[J]. Front Psychiatry，2020，11：741. DOI：10.3389/fpsyt.2020.00741.
[87]	HERPERTZ-DAHLMANN B. Adolescent eating disorders：update on definitions，symptomatology，epidemiology，and comorbidity[J]. Child Adolesc Psychiatr Clin N Am，2015，24（1）：177-196. DOI：10.1016/j.chc.2014.08.003.
[88]	SONNEVILLE K R，HORTON N J，MICALI N，et al. Longitudinal associations between binge eating and overeating and adverse outcomes among adolescents and young adults：does loss of control matter?[J]. JAMA Pediatr，2013，167（2）：149-155. DOI：10.1001/2013.jamapediatrics.12.
[89]	CZAJA J，RIEF W，HILBERT A. Emotion regulation and binge eating in children[J]. Int J Eat Disord，2009，42（4）：356-362. DOI：10.1002/eat.20630.
[90]	DEBAR L L，WILSON G T，YARBOROUGH B J，et al. Cognitive behavioral treatment for recurrent binge eating in adolescent girls：a pilot trial[J]. Cogn Behav Pract，2013，20（2）：147-161. DOI：10.1016/j.cbpra.2012.04.001.
[91]	JONES M，LUCE K H，OSBORNE M I，et al. Randomized，controlled trial of an internet-facilitated intervention for reducing binge eating and overweight in adolescents[J]. Pediatrics，2008，121（3）：453-462. DOI：10.1542/peds.2007-1173.
[92]	TANOFSKY-KRAFF M，SHOMAKER L B，WILFLEY D E，et al. Targeted prevention of excess weight gain and eating disorders in high-risk adolescent girls：a randomized controlled trial[J]. Am J Clin Nutr，2014，100（4）：1010-1018. DOI：10.3945/ajcn.114.092536.
[93]	SAFER D L，COUTURIER J L，LOCK J. Dialectical behavior therapy modified for adolescent binge eating disorder：a case report[J]. Cogn Behav Pract，2007，14（2）：157-167. DOI：10.1016/j.cbpra.2006.06.001.
[94]	MAZZEO S E，LYDECKER J，HARNEY M，et al. Development and preliminary effectiveness of an innovative treatment for binge eating in racially diverse adolescent girls[J]. Eat Behav，2016，22：199-205. DOI：10.1016/j.eatbeh.2016.06.014.
[95]	BOHON C. Binge Eating Disorder in Children and Adolescents[J.] Child and Adolescent Psychiatric Clinics of North America. 2019，28（4）：549-555. DOI：10.1016/j.chc.2019.05.003.

推荐强度	证据级别	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	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

心理治疗类型	治疗目标	推荐疗程	推荐强度/证据级别
认知行为治疗	第一阶段：自我监测，识别有问题的饮食模式，建立正常的饮食模式第二阶段以认知为导向，包括教患者识别和重建关于其身体形象和饮食的适应不良想法（即"认知重建"），以及教授解决问题的技能，以更好地应对压力情况、人际互动和暴食的触发因素第三阶段的重点是保持正常饮食，巩固新的认知和解决问题的能力，并学习预防复发的方法	12~24周，每周1次	A1a
辩证行为治疗	使BED患者发展出具有适应性的情绪调节技能，并能在日常生活中应用	1年，包含有（1）每周与治疗师的单独会谈；（2）每周在团体中的技能训练；（3）两次会谈期间通过电话进行的技能指导；（4）DBT治疗师团队每周一起讨论病情及治疗进展，以支持治疗（患者不参与）	B3a
人际心理治疗	聚焦于识别和改变导致暴食问题发生、发展和持续的人际关系问题	4~5个月，15~20次访谈	B3a
正念饮食觉知训练	正念被整合到与食物渴望和饮食相关的日常活动中。其基于我们目前对食物摄入调节过程的了解，包括觉察饥饿和饱胀感，将主要注意力放在饮食模式上	10次，包含有正念、正念饮食、情绪平衡、自我接纳	B2b
行为减重治疗	一种结构化的行为生活方式方法，让患者在正常化和构建饮食模式的同时增加身体活动。适合BED合并肥胖的患者，应联合使用CBT或药物治疗		B3a

心理治疗类型	治疗目标	推荐疗程	推荐强度/证据级别
认知行为治疗	第一阶段：自我监测，识别有问题的饮食模式，建立正常的饮食模式第二阶段以认知为导向，包括教患者识别和重建关于其身体形象和饮食的适应不良想法（即"认知重建"），以及教授解决问题的技能，以更好地应对压力情况、人际互动和暴食的触发因素第三阶段的重点是保持正常饮食，巩固新的认知和解决问题的能力，并学习预防复发的方法	12~24周，每周1次	A1a
辩证行为治疗	使BED患者发展出具有适应性的情绪调节技能，并能在日常生活中应用	1年，包含有（1）每周与治疗师的单独会谈；（2）每周在团体中的技能训练；（3）两次会谈期间通过电话进行的技能指导；（4）DBT治疗师团队每周一起讨论病情及治疗进展，以支持治疗（患者不参与）	B3a
人际心理治疗	聚焦于识别和改变导致暴食问题发生、发展和持续的人际关系问题	4~5个月，15~20次访谈	B3a
正念饮食觉知训练	正念被整合到与食物渴望和饮食相关的日常活动中。其基于我们目前对食物摄入调节过程的了解，包括觉察饥饿和饱胀感，将主要注意力放在饮食模式上	10次，包含有正念、正念饮食、情绪平衡、自我接纳	B2b
行为减重治疗	一种结构化的行为生活方式方法，让患者在正常化和构建饮食模式的同时增加身体活动。适合BED合并肥胖的患者，应联合使用CBT或药物治疗		B3a

中国暴食障碍诊疗专家共识

Chinese Expert Consensus on the Diagnosis and Treatment of Binge Eating Disorder

RichHTML

PDF

可视化

摘要/Abstract

引用本文

使用本文

图/表 2

参考文献 95

相关文章 15

编辑推荐

Metrics

留言

[1]	国家感染性疾病临床医学研究中心江西分中心, 江西省结核病重点实验室. 肺结核合并慢性乙型肝炎病毒感染者治疗专家共识[J]. 中国全科医学, 2025, 28(24): 2961-2967.
[2]	中国老年医学学会, 浙江省医学会全科医学分会, 全科未分化疾病专家协作组. 消瘦诊治与管理专家共识（2025）[J]. 中国全科医学, 2025, 28(21): 2577-2594.
[3]	尹营营, 赵宽, 王彩莲, 汤立晨, 何红波, 刘向欣, 潘昱, 杨海龙, 杨阳, 周波, 谢可, 林铮, 喻林珍, 骆艳丽, 陆峥, 王小平, 任涛, 邹韶红, 魏镜, 冯威, 袁勇贵. 肿瘤患者心身症状临床管理中国专家共识[J]. 中国全科医学, 2025, 28(15): 1809-1822.
[4]	首都医科大学肿瘤学系妇科肿瘤学组. 妇科常见恶性肿瘤全专结合管理专家共识[J]. 中国全科医学, 2025, 28(08): 911-922.
[5]	张文杰, 李军, 陈恒文, 谭雨晴, 解紫从, 武佶, 孟超, 李赵陵, 张乐松. 《心悸（心律失常-室性早搏）多民族医诊疗专家共识》临床问题与结局指标的收集与确定[J]. 中国全科医学, 2025, 28(04): 407-412.
[6]	清华大学万科公共卫生与健康学院, 北京大学公共卫生学院, 中国医师协会全科医师分会. 智能全科医生中国专家共识[J]. 中国全科医学, 2025, 28(02): 135-142.
[7]	公共安全科学技术学会公共卫生安全与健康专业委员会, 中国医师协会全科医师分会. 基层健康治理专家共识2024[J]. 中国全科医学, 2025, 28(01): 13-19.
[8]	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.
[9]	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.
[10]	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.
[11]	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.
[12]	卢娜, 刘华清, 季蕴辛, 郭蓉娟, 贺丹军, 焦志安, 林越瑞, 田峰, 张桂青, 徐治, 安钢辉, 张燕, 袁勇贵. 考试焦虑障碍临床诊疗中国专家共识[J]. 中国全科医学, 2024, 27(34): 4225-4233.
[13]	中国微循环学会糖尿病与微循环专业委员会, 中华医学会内分泌学分会基层内分泌代谢病学组. 基层糖尿病微血管疾病筛查与防治专家共识（2024）[J]. 中国全科医学, 2024, 27(32): 3969-3986.
[14]	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.
[15]	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.