暴食症的诊断、治疗及其疗效

The Diagnosis,Therapy and Therapeutic Potency of Binge Eating Disorder(BED)

暴食症已成为目前世界上广泛流行的三大进食障碍之一,我国患者亦不在少数并有增加之势,但对暴食症的研究与治疗尚属起步阶段。文章回顾了暴食症的表征及其诊断技术,简要介绍了常见的三种治疗方法(即行为疗法、认知疗法及伴随症状改善法),并讨论了影响暴食症疗效的诸个体因素。暴食症的诊断主要是根据美国精神疾病诊断与统计手册第四版(DSM-Ⅳ)、进食障碍检测评估表(EDE)(治疗者用)和进食障碍检测问卷(EDE-Q)(患者用),并结合过往病史和伴随症状。三类治疗方法在理论与操作层面各有倚重,均可收到一定治疗效果。但各疗法的效果与预后会因患者而异甚或迥乎相异,这是因为暴食症疗效还受到患者自身人格、社会和认知诸因素的影响,治疗者应根据特定患者选择适合该患者的疗法。

Binge eating disorder（BED） has been proved to be one of the three most prevalent eating disorders in the world.In China, the number of those who are suffering from BED is not small and on the rise.BED patients are suffering with an irresistible desire and behavior to eat whatever food at any time and any place,until they feel painful to eat any more.BED patients also have false conviction in their weight and body shape as other eating disorder patients do.But they don＇t try to control their weight using methods as vomitting as bulimia nervosa patients will.Systematically,this article reviews the syndromes that symbolize BED and the criteria for diagnosing BED,with an introduction of three commonly-used therapeutic methods for BED（i.e.,the behavioral therapy,the cognitive therapy, and the therapy for improving other concomitant symptoms of BED）,and a discussion of clients＇ personal factors that could affect the therapeutic potency.The diagnosis of BED mainly depends on the Diagnostic and Statistical Manual of Mental Disorders（DSM -Ⅳ）, Eating Disorder Examination（EDE）（investigator/interviewer-based） and Eating Disorder Examination Questionnaire（EDE-Q） （clients/interviewee - based）.A clients＇ medical history and concomitant symptoms are also considered as supplementary evidences to diagnose BED.Each of the three therapies places emphasis on different parts in theory and in practice,and has its own advantages and disadvantages.The key concept of the behavioral therapy is to change the unhealthy eating behavior using methods such as Behavioral Weight Loss（BWL） and Dialectical Behavior Therapy（DBT）;while the cognitive therapy is to change the false conviction,such as Cognitive Behavior Therapy（CBT）,Art Therapy（AT） and Experiential Cognitive Therapy（Experiential CT）;and the therapy for improving other concomitant symptoms is to help BED patients solve other problems like maladjustment or depression using methods,such as Interpersonal Therapy（IPT）.Although each of the three kinds of therapy has been confirmed to lead to good results,specific thera- peutic potencies vary dramatically with different patients.The reason is that therapeutic potencies are also influenced by the personality, social and cognitive factors of patients,which implies that treatments should be chosen according to a specific patient.