Haller E
Langley Porter Psychiatric Institute, University of California, San Francisco, School of Medicine 94143.
West J Med. 1992 Dec;157(6):658-62.
Anorexia nervosa and bulimia nervosa are prevalent illnesses affecting between 1% and 10% of adolescent and college age women. Developmental, family dynamic, and biologic factors are all important in the cause of this disorder. Anorexia nervosa is diagnosed when a person refuses to maintain his or her body weight over a minimal normal weight for age and height, such as 15% below that expected, has an intense fear of gaining weight, has a disturbed body image, and, in women, has primary or secondary amenorrhea. A diagnosis of bulimia nervosa is made when a person has recurrent episodes of binge eating, a feeling of lack of control over behavior during binges, regular use of self-induced vomiting, laxatives, diuretics, strict dieting, or vigorous exercise to prevent weight gain, a minimum of 2 binge episodes a week for at least 3 months, and persistent overconcern with body shape and weight. Patients with eating disorders are usually secretive and often come to the attention of physicians only at the insistence of others. Practitioners also should be alert for medical complications including hypothermia, edema, hypotension, bradycardia, infertility, and osteoporosis in patients with anorexia nervosa and fluid or electrolyte imbalance, hyperamylasemia, gastritis, esophagitis, gastric dilation, edema, dental erosion, swollen parotid glands, and gingivitis in patients with bulimia nervosa. Treatment involves combining individual, behavioral, group, and family therapy with, possibly, psychopharmaceuticals. Primary care professionals are frequently the first to evaluate these patients, and their encouragement and support may help patients accept treatment. The treatment proceeds most smoothly if the primary care physician and psychiatrist work collaboratively with clear and frequent communication.
神经性厌食症和神经性贪食症是常见疾病，影响着1%至10%的青春期和大学年龄段女性。发育、家庭动态和生物学因素在这种疾病的病因中都很重要。当一个人拒绝维持其体重在与其年龄和身高相应的最低正常体重之上，比如低于预期体重的15%，强烈害怕体重增加，身体形象紊乱，并且在女性中出现原发性或继发性闭经时，可诊断为神经性厌食症。当一个人有反复的暴饮暴食发作，在暴食期间感觉对行为缺乏控制，经常自行催吐、使用泻药、利尿剂、严格节食或剧烈运动以防止体重增加，每周至少有2次暴食发作且持续至少3个月，并且持续过度关注体型和体重时，可诊断为神经性贪食症。饮食失调患者通常遮遮掩掩，往往只有在他人坚持下才会引起医生注意。从业者还应警惕神经性厌食症患者出现的医学并发症，包括体温过低、水肿、低血压、心动过缓、不孕和骨质疏松，以及神经性贪食症患者出现的液体或电解质失衡、高淀粉酶血症、胃炎、食管炎、胃扩张、水肿、牙齿侵蚀、腮腺肿大和牙龈炎。治疗包括将个体、行为、团体和家庭治疗与可能的精神药物相结合。初级保健专业人员常常是首批评估这些患者的人，他们的鼓励和支持可能有助于患者接受治疗。如果初级保健医生和精神科医生通过清晰且频繁的沟通进行协作，治疗进展会最为顺利。
