Gómez Candela Carmen, Palma Milla Samara, Miján-de-la-Torre Alberto, Rodríguez Ortega Pilar, Matía Martín Pilar, Loria Cohen Viviana, Campos Del Portillo Rocío, Virgili Casas M ª Nuria, Martínez Olmos Miguel Á, Mories Álvarez M ª Teresa, Castro Alija M ª José, Martín-Palmero Ángela
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Nutr Hosp. 2018 Mar 7;35(Spec No1):49-97. doi: 10.20960/nh.1562.
Bulimia nervosa and binge eating disorder are unique nosological entities. Both show a large variability related to its presentation and severity which involves different therapeutic approaches and the need to individualize the treatment, thus it is indispensable a multidisciplinary approach. Patients with bulimia nervosa may suffer from malnutrition and deficiency states or even excess weight, while in binge eating disorders, it is common overweight or obesity, which determine other comorbidities. Many of the symptoms and complications are associated with compensatory behaviors. There are many therapeutic tools available for the treatment of these patients. The nutritional approach contemplates the individualized dietary advice which guarantees an adequate nutritional state and nutritional education. Its objective is to facilitate the voluntary adoption of eating behaviors that promote health and allow the long-term modification of eating habits and the cessation of purgatory and bingeing behaviors. Psychological support is a first-line treatment and it must address the frequent disorder of eating behavior and psychiatric comorbidities. Psychotropic drugs are effective and widely used although these drugs are not essential. The management is carried out mainly at an outpatient level, being the day hospital useful in selected patients. Hospitalization should be reserved to correct serious somatic or psychiatric complications or as a measure to contain non-treatable conflict situations. Most of the guidelines' recommendations are based on expert consensus, with little evidence which evaluates clinical results and cost-effectiveness.
神经性贪食症和暴饮暴食症是独特的疾病实体。两者在临床表现和严重程度上都有很大差异，这涉及不同的治疗方法以及个体化治疗的必要性，因此多学科方法必不可少。神经性贪食症患者可能会出现营养不良和缺乏状态，甚至体重超标，而在暴饮暴食症中，超重或肥胖很常见，这会导致其他合并症。许多症状和并发症都与代偿行为有关。有许多治疗工具可用于治疗这些患者。营养方法考虑个体化的饮食建议，以保证充足的营养状态并进行营养教育。其目标是促进自愿采用促进健康的饮食行为，并允许长期改变饮食习惯以及停止催吐和暴饮暴食行为。心理支持是一线治疗方法，必须解决常见的饮食行为障碍和精神合并症。精神药物有效且广泛使用，尽管这些药物并非必不可少。治疗主要在门诊进行，日间医院对部分患者有用。住院治疗应仅用于纠正严重的躯体或精神并发症，或作为控制无法治疗的冲突情况的措施。大多数指南的建议基于专家共识，评估临床结果和成本效益的证据很少。
