Wilfley D E, Cohen L R
San Diego State University/University of California, USA.
Psychopharmacol Bull. 1997;33(3):437-54.
The field of eating disorders has grown rapidly, amassing an impressive body of treatment research in the past 20 years. In particular, researchers have focused on binge eating problems, which include bulimia nervosa (BN) and the more recently recognized binge eating disorder (BED). Numerous controlled treatment trials have shown cognitive-behavioral therapy (CBT) to be equally or more efficacious than any other BN treatment to which it has been compared. Although CBT also seems to be effective for BED, research is in a preliminary stage. Further combinations and adaptations of treatments for BED are needed to address the additional problem of obesity in this population. Preliminary data suggest that behavioral weight control treatment for BED is effective in reducing binge eating, and it may have the added benefit of weight loss. Interpersonal psychotherapy (IPT), the combination of CBT and medication, and self-help manuals are promising treatment alternatives for both BN and BED. Future treatment trials should include longer-term followup periods and more consistent definitions of successful treatment outcome. In addition, further study is needed in the areas of treatment nonresponders, pre-treatment predictors, a stepped-care treatment model, and methods for a wider dissemination of validated treatments.
饮食失调领域发展迅速，在过去20年里积累了大量令人瞩目的治疗研究成果。特别是，研究人员一直专注于暴饮暴食问题，其中包括神经性贪食症（BN）和最近才被认可的暴饮暴食症（BED）。众多对照治疗试验表明，认知行为疗法（CBT）与其他已被比较的BN治疗方法相比，疗效相当或更显著。虽然CBT对BED似乎也有效，但研究尚处于初步阶段。需要对BED的治疗方法进行进一步的组合和调整，以解决该人群中额外的肥胖问题。初步数据表明，针对BED的行为体重控制治疗在减少暴饮暴食方面是有效的，而且可能还有助于减肥。人际心理治疗（IPT）、CBT与药物的联合使用以及自助手册是BN和BED都很有前景的治疗选择。未来的治疗试验应包括更长的随访期以及对成功治疗结果更一致的定义。此外，在治疗无反应者、治疗前预测因素、阶梯式护理治疗模式以及更广泛传播经过验证的治疗方法的途径等方面，还需要进一步研究。
