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[回避/限制性食物摄入障碍:诊断系统中的一种新的喂养及进食障碍]

[The avoidant/restrictive food intake disorder: a new feeding and eating disorder in the diagnostic systems].

作者信息

Demetrovics Orsolya, Demetrovics Zsolt

机构信息

Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary, E-mail:

出版信息

Psychiatr Hung. 2025;40(1):70-83.

Abstract

The Avoidant-restrictive Food Intake Disorder (ARFID) was included in the fifth edition of the DSM in 2013 and in the BNO-11 diagnostic manual in 2019. Prior to this, the problem was often unrecognised or diagnosed as an eating disorder not otherwise specified or feeding and eating disorders of infancy or early childhood. The new diagnosis allows for better targeting of patients who have not been diagnosed earlier, as well as for the diagnosis of patients over the age of six. The authors, in their review, describe the diagnostic features and symptom profile of ARFID, and they discuss the role of the main etiological factors involved in its development, such as sensory hypersensitivity, congenitally strong aversive and neophobic reactions, cognitive rigidity, high levels of anxiety, relative insensitivity to interoceptive cues of hunger, and characteristic taste and smell preferences. Different treatment options are also discussed. Although there are still gaps in evidence-based treatments due to the short history of the diagnosis, some existing therapies with some modifications or newer approaches may be well suited to treat ARFID. In addition to cognitive behavioural therapy, exposure therapy, and family-based treatment approaches with modifications, the importance of psychoeducation of parents and a family-tailored treatment plan is emphasised. The authors highlight that effective approaches to ARFID are often counter-intuitive, making it of paramount importance to gain the trust and cooperation of parents.

摘要

回避性限制性食物摄入障碍(ARFID)于2013年被纳入《精神疾病诊断与统计手册》第五版,并于2019年被纳入《国际疾病分类第11版》诊断手册。在此之前,这个问题常常未被识别或被诊断为未另行规定的进食障碍或婴儿期或幼儿期的喂养和进食障碍。新的诊断方式能够更好地针对那些早期未被诊断的患者,以及对六岁以上的患者进行诊断。作者在综述中描述了ARFID的诊断特征和症状概况,并讨论了其发展过程中主要病因因素所起的作用,如感觉超敏、先天性强烈的厌恶和新恐惧症反应、认知僵化、高度焦虑、对饥饿的内感受性线索相对不敏感以及特有的味觉和嗅觉偏好。文中还讨论了不同的治疗选择。尽管由于该诊断的历史较短,循证治疗仍存在差距,但一些经过调整的现有疗法或更新的方法可能非常适合治疗ARFID。除了认知行为疗法、暴露疗法以及经过调整的基于家庭的治疗方法外,还强调了对父母进行心理教育和制定家庭定制治疗计划的重要性。作者强调,治疗ARFID的有效方法往往有违直觉,因此获得父母的信任与合作至关重要。

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