Hagan Kelsey E, Walsh B Timothy
Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA.
Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA.
Clin Ther. 2021 Jan;43(1):40-49. doi: 10.1016/j.clinthera.2020.10.012. Epub 2020 Dec 23.
Bulimia nervosa (BN) is an eating disorder characterized by binge eating, inappropriate compensatory behaviors, and body image concerns in persons at or above a healthy weight. BN is a serious disorder with medical sequelae and marked psychosocial impairment. To reduce and eliminate symptoms of BN, psychological and pharmacologic treatments for BN have been developed. We review the current state-of-the-art treatments for BN.
We conducted a narrative review of the BN treatment literature to synthesize the current evidence base, provide recommendations, and propose future directions for BN treatment research.
Currently, the first-line, state-of-the-art treatment for adults with BN is cognitive-behavioral therapy (CBT). Interpersonal therapy is a second-line evidence-based treatment for adults with BN, and dialectical behavior therapy and integrative cognitive-affective therapy are also promising. For BN in adolescents, family-based treatment for BN or CBT are evidence-based approaches. Pharmacotherapy is best considered adjunctive to psychotherapy in adults with BN but may be helpful, depending on the type of psychotherapy and whether psychotherapy is ineffective or unavailable. Fluoxetine 60 mg/d is the medication of choice for adults with BN. Little is known with respect to pharmacologic treatment of BN in adolescents, although fluoxetine 60 mg/d holds promise.
Despite decades of treatment-development research in BN, there is room for improvement because nearly 60% of those with BN do not achieve remission with specialty treatment and strikingly few randomized controlled trials for BN in adolescents exist. Moreover, the field should address issues related to treatment dissemination, access, and cost.
神经性贪食症（BN）是一种进食障碍，其特征为暴饮暴食、不适当的代偿行为以及体重处于或高于健康水平者对身体形象的关注。BN是一种严重的疾病，会引发医学后遗症并导致明显的心理社会功能损害。为了减轻和消除BN的症状，已开发出针对BN的心理和药物治疗方法。我们对BN当前的先进治疗方法进行综述。
我们对BN治疗文献进行了叙述性综述，以综合当前的证据基础，提供建议，并为BN治疗研究提出未来方向。
目前，针对成年BN患者的一线先进治疗方法是认知行为疗法（CBT）。人际治疗是成年BN患者的二线循证治疗方法，辩证行为疗法和综合认知情感疗法也很有前景。对于青少年BN患者，基于家庭的BN治疗或CBT是循证方法。药物治疗在成年BN患者中最好被视为心理治疗的辅助手段，但可能会有帮助，这取决于心理治疗的类型以及心理治疗是否无效或无法获得。60毫克/天的氟西汀是成年BN患者的首选药物。对于青少年BN的药物治疗知之甚少，尽管60毫克/天的氟西汀有一定前景。
尽管在BN治疗开发研究方面已经进行了数十年，但仍有改进空间，因为近60%的BN患者在接受专科治疗后未能实现缓解，而且针对青少年BN的随机对照试验极少。此外，该领域应解决与治疗传播、可及性和成本相关的问题。
