中国暴食障碍诊疗专家共识

doi:10.12114/j.issn.1007-9572.2024.0030

中国全科医学 ›› 2024, Vol. 27 ›› Issue (24): 2941-2953.DOI: 10.12114/j.issn.1007-9572.2024.0030

• 指南·共识 • 下一篇

中国暴食障碍诊疗专家共识

中华医学会心身医学分会进食障碍协作学组, 中华医学会精神医学分会进食障碍研究协作组, 彭素芳¹, 何欠欠², 刘强¹, 陈妍¹, 张岚³, 李雪霓⁴, 乔慧芬⁵, 孔庆梅⁴, 匡桂芳⁶, 陈涵¹, 虞阳⁷, 蒋晶晶⁸, 刘兰英¹, 张大荣⁴, 栗克清⁹, 王振¹, 陈珏^*()

1．200030　上海市，上海交通大学医学院附属精神卫生中心
2．200120　上海市，同济大学附属精神卫生中心（筹）
3．610041　四川省成都市，四川大学华西医院心理卫生中心
4．100091　北京市，北京大学第六医院　北京大学精神卫生研究所　国家卫生健康委员会精神卫生学重点实验室（北京大学）　国家精神心理疾病临床医学研究中心（北京大学第六医院）
5．210029　江苏省南京市，南京医科大学附属脑科医院
6．266034　山东省青岛市，青岛大学附属妇女儿童医院
7．200040　上海市，复旦大学附属华东医院
8．200030　上海市，复旦大学附属中山医院
9．071000　河北省保定市，河北省精神卫生中心

收稿日期:2024-03-05 修回日期:2024-04-20 出版日期:2024-08-20 发布日期:2024-05-08
通讯作者: 陈珏
基金资助:
国家自然科学基金面上项目(820715451); 上海市卫生健康委员会面上项目(202140092); 上海市科学技术委员会医学创新研究专项项目(20Y119065003); 上海市精神心理疾病临床医学研究中心项目(19MC1911100); 上海市精神卫生中心院级重点课题(2020zd02)

Chinese Expert Consensus on the Diagnosis and Treatment of Binge Eating Disorder

Eating Disorders Coordination Group of the Psychosomatic Medicine Society of the Chinese Medical Association, Eating Disorders Research Collaboration Group of the Psychiatric Medicine Society of the Chinese Medical Association, PENG Sufang¹, HE Qianqian², LIU Qiang¹, CHEN Yan¹, ZHANG Lan³, LI Xueni⁴, QIAO Huifen⁵, KONG Qingmei⁴, KUANG Guifang⁶, CHEN Han¹, YU Yang⁷, JIANG Jingjing⁸, LIU Lanying¹, ZHANG Darong⁴, LI Keqing⁹, WANG Zhen¹, CHEN Jue¹^,^*()

1. Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
2. Mental Health Center of Tongji University, Shanghai 200120, China
3. Mental Health Center, West China Hospital, Sichuan University, Chengdu 610041, China
4. Peking University Sixth Hospital/Peking University Institute of Mental Health/NHC Key Laboratory of Mental Health (Peking University) /National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100091, China
5. Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing 210029, China
6. Women and Children's Hospital, Qingdao University, Qingdao 266034, China
7. Huadong Hospital Affiliated to Fudan University, Shanghai 200040, China
8. Zhongshan Hospital Affiliated to Fudan University, Shanghai 200030, China
9. Hebei Mental Health Center, Baoding 071000, China

Received:2024-03-05 Revised:2024-04-20 Published:2024-08-20 Online:2024-05-08
Contact: CHEN Jue

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摘要/Abstract

摘要： 暴食障碍是以反复发作性暴食为主要特征的一类进食障碍。暴食障碍患者存在反复发作、冲动性、失控性的暴食行为，可导致胃肠道疾病、高血压、肥胖及由此引起的代谢和各系统功能紊乱等躯体问题；也常共病心境障碍、焦虑障碍、物质使用障碍等多种精神障碍，需引起重视。然而，国内对暴食障碍的认识较晚，目前难以做到早期识别和诊治，导致病程迁延。因此，在中华医学会心身医学分会进食障碍协作学组的组织下，联合中华医学会精神医学分会进食障碍研究协作组，由15名精神科专家及循证医学专家，2名内科专家组成《中国暴食障碍诊疗专家共识》专家组，基于循证医学证据、国内外指南与专家共识、专家经验等制订本专家共识，以期提高国内精神科专业人员、内科医师和全科医师对暴食障碍的识别和诊治水平。

关键词: 暴食症, 饮食与进食障碍, 心理治疗, 药物治疗, 专家共识

Abstract:

Binge-eating disorder (BED) is a type of eating disorder characterized by recurrent episodes of binge eating. Patients with BED have recurrent impulsive and out-of-controlled binge eating behavior, which can lead to gastrointestinal disorders, obesity, and the resulting metabolic and functional disorders of various systems and other physical problems; and it is also often co-morbid with affective disorder, anxiety disorders, substance use disorders, and other mental disorders, which need to be taken seriously. However, the recognition of BED in China was late, and it is difficult to achieve early identification and diagnosis, resulting in a prolonged course of disease. Therefore, under the organization of the Eating Disorders Coordination Group of the Psychosomatic Medicine Society of the Chinese Medical Association, together with the Eating Disorders Research Collaboration Group of the Psychiatric Medicine Society of the Chinese Medical Association, an expert group composed of 15 psychiatrists and evidence-based medicine experts, and 2 internal medicine experts, formulated this expert consensus based on evidence-based medical evidence, domestic and foreign guidelines and expert consensus, and expert experiences. The aim of this study is to improve the recognition, diagnosis and treatment of BED by psychiatrists, internists and general practitioners in China.

Key words: Binge-eating disorder, Feeding and eating disorders, Psychological treatment, Drug therapy, Expert consensus

中华医学会心身医学分会进食障碍协作学组,中华医学会精神医学分会进食障碍研究协作组,彭素芳,等. 中国暴食障碍诊疗专家共识[J]. 中国全科医学, 2024, 27(24): 2941-2953. DOI: 10.12114/j.issn.1007-9572.2024.0030.
Eating Disorders Coordination Group of the Psychosomatic Medicine Society of the Chinese Medical Association,Eating Disorders Research Collaboration Group of the Psychiatric Medicine Society of the Chinese Medical Association,PENG Sufang, et al. Chinese Expert Consensus on the Diagnosis and Treatment of Binge Eating Disorder[J]. Chinese General Practice, 2024, 27(24): 2941-2953. DOI: 10.12114/j.issn.1007-9572.2024.0030.

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推荐强度	证据级别	病因、治疗、预防
A	1a	多个同质随机对照研究的系统综述
	1b	单个随机对照研究
	1c	"全或无"证据
B	2a	同质性队列研究的系统综述
	2b	单一的队列研究（包括低质量的随机对照研究，如随访率<80%）
	2c	结局性研究
	3a	同质性病例对照研究的系统综述
	3b	单独的病例对照研究
C	4	病例系列
D	5	没有严格评价的专家意见，或完全基于生理学和基础研究

推荐强度	证据级别	病因、治疗、预防
A	1a	多个同质随机对照研究的系统综述
	1b	单个随机对照研究
	1c	"全或无"证据
B	2a	同质性队列研究的系统综述
	2b	单一的队列研究（包括低质量的随机对照研究，如随访率<80%）
	2c	结局性研究
	3a	同质性病例对照研究的系统综述
	3b	单独的病例对照研究
C	4	病例系列
D	5	没有严格评价的专家意见，或完全基于生理学和基础研究

心理治疗类型	治疗目标	推荐疗程	推荐强度/证据级别
认知行为治疗	第一阶段：自我监测，识别有问题的饮食模式，建立正常的饮食模式第二阶段以认知为导向，包括教患者识别和重建关于其身体形象和饮食的适应不良想法（即"认知重建"），以及教授解决问题的技能，以更好地应对压力情况、人际互动和暴食的触发因素第三阶段的重点是保持正常饮食，巩固新的认知和解决问题的能力，并学习预防复发的方法	12~24周，每周1次	A1a
辩证行为治疗	使BED患者发展出具有适应性的情绪调节技能，并能在日常生活中应用	1年，包含有（1）每周与治疗师的单独会谈；（2）每周在团体中的技能训练；（3）两次会谈期间通过电话进行的技能指导；（4）DBT治疗师团队每周一起讨论病情及治疗进展，以支持治疗（患者不参与）	B3a
人际心理治疗	聚焦于识别和改变导致暴食问题发生、发展和持续的人际关系问题	4~5个月，15~20次访谈	B3a
正念饮食觉知训练	正念被整合到与食物渴望和饮食相关的日常活动中。其基于我们目前对食物摄入调节过程的了解，包括觉察饥饿和饱胀感，将主要注意力放在饮食模式上	10次，包含有正念、正念饮食、情绪平衡、自我接纳	B2b
行为减重治疗	一种结构化的行为生活方式方法，让患者在正常化和构建饮食模式的同时增加身体活动。适合BED合并肥胖的患者，应联合使用CBT或药物治疗		B3a

心理治疗类型	治疗目标	推荐疗程	推荐强度/证据级别
认知行为治疗	第一阶段：自我监测，识别有问题的饮食模式，建立正常的饮食模式第二阶段以认知为导向，包括教患者识别和重建关于其身体形象和饮食的适应不良想法（即"认知重建"），以及教授解决问题的技能，以更好地应对压力情况、人际互动和暴食的触发因素第三阶段的重点是保持正常饮食，巩固新的认知和解决问题的能力，并学习预防复发的方法	12~24周，每周1次	A1a
辩证行为治疗	使BED患者发展出具有适应性的情绪调节技能，并能在日常生活中应用	1年，包含有（1）每周与治疗师的单独会谈；（2）每周在团体中的技能训练；（3）两次会谈期间通过电话进行的技能指导；（4）DBT治疗师团队每周一起讨论病情及治疗进展，以支持治疗（患者不参与）	B3a
人际心理治疗	聚焦于识别和改变导致暴食问题发生、发展和持续的人际关系问题	4~5个月，15~20次访谈	B3a
正念饮食觉知训练	正念被整合到与食物渴望和饮食相关的日常活动中。其基于我们目前对食物摄入调节过程的了解，包括觉察饥饿和饱胀感，将主要注意力放在饮食模式上	10次，包含有正念、正念饮食、情绪平衡、自我接纳	B2b
行为减重治疗	一种结构化的行为生活方式方法，让患者在正常化和构建饮食模式的同时增加身体活动。适合BED合并肥胖的患者，应联合使用CBT或药物治疗		B3a

中国暴食障碍诊疗专家共识

Chinese Expert Consensus on the Diagnosis and Treatment of Binge Eating Disorder

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