Contexto Clínico

A bulimia nervosa (ICD-11 6B81) é tratada principalmente em regime ambulatorial. As diretrizes internacionais posicionam de forma consistente a terapia ambulatorial estruturada como centro do tratamento inicial, com a escolha da modalidade orientada pela adequação do paciente e pela disponibilidade local.

Abordagem Terapêutica — Visão Parcial

O tratamento de primeira linha baseia-se na psicoterapia ambulatorial estruturada. A terapia cognitivo-comportamental é amplamente reconhecida em múltiplas diretrizes como uma modalidade central de primeira linha, embora o protocolo completo inclua opções psicoterapêuticas adicionais baseadas em evidências e o papel do aconselhamento nutricional no plano geral. A estrutura completa — incluindo os formatos preferenciais, o sequenciamento e as intervenções adjuvantes — está disponível no protocolo completo.

References

DOI: 10.1097/YCO.0000000000000360

Among the guidelines reporting on the prioritized treatment setting of BN, all recommended outpatient therapy as a first-line treatment (n = 5).
In agreement, five guidelines recommended cognitive-behavioral therapy as a first-line psychotherapy for patients with BN, particularly in an individual format.
The remaining two guidelines also made recommendations in favor of cognitive-behavioral interventions, but prioritized cognitive-behavioral, guided self-help treatment as a first-line treatment (the United Kingdom), or did not provide an explicit treatment hierarchy (Spain).
Overall, among the six guidelines which recommended self-help approaches, four highlighted the use of guided self-help based on cognitive-behavioral interventions (Australia and New Zealand, Germany, The Netherlands, the United Kingdom), that is, using structured self-help manuals supplemented with brief supportive sessions.
Interpersonal psychotherapy was recommended as an alternative to cognitive-behavioral therapy by most guidelines (n = 4), while psychodynamic therapy (n = 2) was rarely recommended.
Other than the WFSBP guideline, all available guidelines issued recommendations on specific psychological interventions.

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Qual É o Tratamento de Primeira Linha da Bulimia Nervosa?

References