Disorders - Bulimia Nervosa
Ciao, A. C., Accurso, E. C., Fitzsimmons-Craft, E. E., Le-Grange, D.
This study examined predictors of psychological change among
80 adolescents with bulimia nervosa (BN) participating in a randomized-controlled trial comparing family-based treatment (FBT) to supportive
psychotherapy (SPT). Psychological outcomes (cognitive eating disorder pathology, depression, and self-esteem) were explored at baseline, post-
treatment, and 6-month follow-up. Multi-level growth models examined predictors of rate of change in psychological outcomes and moderators of
treatment effects. All psychological outcomes improved through 6-month follow-up (moderate to large effect sizes) across both treatments. Overall,
few significant predictors were identified. Older adolescents had faster change in self-esteem relative to younger adolescents (p = 0.03).
Adolescents taking psychotropic medication at baseline had faster change in eating concerns relative to adolescents not taking medication (p = 0.02).
Age (p = 0.02) and baseline purging severity (p = 0.03) moderated the relationship between treatment condition and change in eating concerns, where
younger adolescents and individuals with high baseline purging had greater change when treated with FBT relative to SPT. Age and purging did not
significantly moderate change in other psychological outcomes. Bulimic symptom improvement did not predict change in psychological symptoms.
Generally, FBT and SPT were equally efficacious with respect to psychological improvement, although FBT may be more efficacious in younger
adolescents and those with more frequent purging. (PsycINFO Database Record (c) 2015 APA, all rights reserved) (journal abstract).
Behaviour Research & Therapy, 69 : 48-53
- Year: 2015
- Problem: Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Family therapy, Supportive
therapy
Diaz-Ferrer, S., Rodriguez-Ruiz, S., Ortega-Roldan, B., Moreno-Dominguez, S., Fernandez-
Santaella, M.
Background and Objectives: Body exposure improves body image problems in women with eating disorders. However it has almost always been
combined with other interventions. Thus, the efficacy of body exposure alone (i.e., pure exposure) remains largely unclear. We aimed to compare the
efficacy of two body exposure techniques through psychological and neuroendocrine indices recorded within and between successive sessions. Method:
Twenty-nine women with high body dissatisfaction and diagnosis of bulimia nervosa were randomly assigned to one of two treatment groups: Pure
Exposure (n = 14) or Guided Exposure (n = 15). Participants received 6 exposure sessions. After each session, changes in thoughts (positive/negative)
and body satisfaction were assessed. Also, we assessed the body discomfort experienced by participants within and between sessions. Finally, the
changes in salivary cortisol levels within and between the initial and final treatment sessions were measured. Results: Both groups showed a
reduction in negative thoughts and a progressive increase in positive thoughts throughout the treatment. However, the increase in body satisfaction
and the reduction in subjective discomfort within the sessions were greater in the pure exposure group. The cortisol levels during the initial and
final treatment sessions decreased in both groups. Limitations: Methodological limitations are reported. Conclusions: These results suggest that pure
and guided exposures are effective interventions for improving thoughts and neuroendocrine responses, although pure exposure increased more body
satisfaction feelings in bulimic women. Subjective discomfort also showed different patterns of change within and along sessions for each treatment.
Reasons for these results are discussed. (PsycINFO Database Record (c) 2015 APA, all rights reserved) (journal abstract).
Journal of Behavior Therapy & Experimental Psychiatry, 48 : 1-
8
- Year: 2015
- Problem: Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Exposure therapy, Exposure
and response prevention
Kim, Y-
R., Eom, J-S., Yang, J-W., Kang, J., Treasure, J.
Background and Aim: Social difficulties and problems related to eating behaviour are common features of both
anorexia nervosa (AN) and bulimia nervosa (BN). The aim of this study was to examine the impact of intranasal oxytocin on consummatory behaviour and
emotional recognition in patients with AN and BN in comparison to healthy controls. Materials: A total of 102 women, including 35 patients with
anorexia nervosa (AN), 34 patients with bulimia nervosa (BN), and 33 healthy university students of comparable age and intelligence, participated in
a double-blind, single dose placebo-controlled cross-over study. A single dose of intranasal administration of oxytocin (40 IU) (or a placebo) was
followed by an emotional recognition task and an apple juice drink. Food intake was then recorded for 24 hours post-test. Results: Oxytocin produced
no significant change in appetite in the acute or 24 hours free living settings in healthy controls, whereas there was a decrease in calorie
consumption over 24 hours in patients with BN. Oxytocin produced a small increase in emotion recognition sensitivity in healthy controls and in
patients with BN, In patients with AN, oxytocin had no effect on emotion recognition sensitivity or on consummatory behaviour. Conclusions: The
impact of oxytocin on appetite and social cognition varied between people with AN and BN. A single dose of intranasal oxytocin decreased caloric
intake over 24 hours in people with BN. People with BN showed enhanced emotional sensitivity under oxytocin condition similar to healthy controls.
Those effects of oxytocin were not found in patients with AN. Trial Registration: ClinicalTrials.gov KCT0000716. (PsycINFO Database Record (c) 2016
APA, all rights reserved) (journal abstract).
PLoS ONE, 10(9) : ArtID
e0137514
- Year: 2015
- Problem: Anorexia Nervosa, Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Other biological interventions
Le-Grange, D., Lock, J., Agras, W., Bryson, S W., Jo, B.
Objective: There is a paucity of randomized clinical trials (RCTs) for adolescents
with bulimia nervosa (BN). Prior studies suggest cognitive-behavioral therapy adapted for adolescents (CBT-A) and family-based treatment for
adolescent bulimia nervosa (FBT-BN) could be effective for this patient population. The objective of this study was to compare the relative efficacy
of these 2 specific therapies, FBT-BN and CBT-A. In addition, a smaller participant group was randomized to a nonspecific treatment (supportive
psychotherapy [SPT]), whose data were to be used if there were no differences between FBT-BN and CBT-A at end of treatment. Method: This 2-site
(Chicago and Stanford) randomized controlled trial included 130 participants (aged 12-18 years) meeting DSM-IV criteria for BN or partial BN (binge
eating and purging once or more per week for 6 months). Outcomes were assessed at baseline, end of treatment, and 6 and 12 months posttreatment.
Treatments involved 18 outpatient sessions over 6 months. The primary outcome was defined as abstinence from binge eating and purging for 4 weeks
before assessment, using the Eating Disorder Examination. Results: Participants in FBT-BN achieved higher abstinence rates than in CBT-A at end of
treatment (39% versus 20%; p = .040, number needed to treat [NNT] = 5) and at 6-month follow-up (44% versus 25%; p = .030, NNT = 5). Abstinence rates
between these 2 groups did not differ statistically at 12-month follow-up (49% versus 32%; p = .130, NNT = 6). Conclusion: In this study, FBT-BN was
more effective in promoting abstinence from binge eating and purging than CBT-A in adolescent BN at end of treatment and 6-month follow-up. By 12-
month follow-up, there were no statistically significant differences between the 2 treatments. (PsycINFO Database Record (c) 2015 APA, all rights
reserved) (journal abstract).
Journal of the American Academy of Child & Adolescent Psychiatry, 54(11) : 886-
894
- Year: 2015
- Problem: Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Family therapy
Lock, J.
Eating
disorders are relatively common and serious disorders in adolescents. However, there are few controlled psychosocial intervention studies with this
younger population. This review updates a previous Journal of Clinical Child and Adolescent Psychology review published in 2008. The recommendations
in this review were developed after searching the literature including PubMed/Medline and employing the relevant medical subject headings. In
addition, the bibliographies of book chapters and treatment guideline articles were reviewed; last, colleagues were asked for suggested additional
source materials. Psychosocial treatments examined include family therapy, individual therapy, cognitive behavioral therapy, interpersonal
psychotherapy, cognitive training, and dialectical behavior therapy. Using the most recent Journal of Clinical Child and Adolescent Psychology
methodological review criteria, family treatment-behavior (FT-B) is the only well-established treatment for adolescents with anorexia nervosa. Family
treatment-systemic and insight oriented individual psychotherapy are probably efficacious treatments for adolescents with anorexia nervosa. There are
no well-established treatments for adolescents with bulimia nervosa, binge eating disorder, or avoidant restrictive food intake disorder. Possibly
efficacious psychosocial treatments for adolescent bulimia nervosa include FT-B and supportive individual therapy. Internet-delivered cognitive
behavioral therapy is a possibly efficacious treatment for binge eating disorder. Experimental treatments for adolescent eating disorders include
enhanced cognitive behavioral therapy, dialectical behavioral therapy, cognitive training, and interpersonal psychotherapy. FT-B is the only well-
established treatment for adolescent eating disorders. Additional research examining treatment for eating disorders in youth is warranted. (PsycINFO
Database Record (c) 2015 APA, all rights reserved) (journal abstract).
Journal of Clinical
Child & Adolescent Psychology, 44(5) : 707-721
- Year: 2015
- Problem: Anorexia Nervosa, Binge Eating Disorders, Bulimia Nervosa, Eating disorders not specified
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Dialectical behavioural therapy
(DBT), Family therapy, Supportive
therapy
Vella-Zarb, R A., Mills, J S., Westra, H A., Carter, J
C., Keating, L.
Objective: Motivational Interviewing (MI) is a collaborative therapy that focuses on strengthening a person's internal motivation to
change. Research suggests that MI may be helpful for treating binge eating; however, findings are limited and little is known about how MI for binge
eating compares to active therapy controls. The present study aimed to build on current research by comparing MI as a prelude to self-help treatment
for binge eating with psychoeducation as a prelude to self-help treatment for binge eating.; Method: Participants with full or subthreshold DSM-IV
Binge Eating Disorder or nonpurging Bulimia Nervosa were randomly assigned to receive either 60 minutes of MI followed by a self-help manual (n = 24)
or 60 minutes of psychoeducation followed by a self-help manual (n?=?21). Questionnaires were completed pre- and postsession, and at 1 and 4 months
postsession.; Results: MI significantly increased readiness to change and confidence in ability to control binge eating, whereas psychoeducation did
not. No group differences were found when changes in eating disorder attitudes and behaviors were examined.; Discussion: MI offers benefits for
increasing motivation and self-efficacy. However, it may not be a uniquely effective treatment approach for reducing binge eating.; © 2014 Wiley
Periodicals, Inc.
International Journal of Eating Disorders, 48(3) : 328-
332
- Year: 2015
- Problem: Binge Eating Disorders, Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention), Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Motivational interviewing, includes Motivational Enhancing Therapy, Psychoeducation
Wonderlich, S. A., Peterson, C. B., Crosby, R. D., Smith, T. L., Klein, M. H., Mitchell, J. E., Crow, S.
J.
Background: The purpose of this
investigation was to compare a new psychotherapy for bulimia nervosa (BN), integrative cognitive-affective therapy (ICAT), with an established
treatment, 'enhanced' cognitive-behavioral therapy (CBT-E).; Method: Eighty adults with symptoms of BN were randomized to ICAT or CBT-E for 21
sessions over 19 weeks. Bulimic symptoms, measured by the Eating Disorder Examination (EDE), were assessed at baseline, at the end of treatment (EOT)
and at the 4-month follow-up. Treatment outcome, measured by binge eating frequency, purging frequency, global eating disorder severity, emotion
regulation, self-oriented cognition, depression, anxiety and self-esteem, was determined using generalized estimating equations (GEEs), logistic
regression and a general linear model (intent-to-treat).; Results: Both treatments were associated with significant improvement in bulimic symptoms
and in all measures of outcome, and no statistically significant differences were observed between the two conditions at EOT or follow-up. Intent-
to-treat abstinence rates for ICAT (37.5% at EOT, 32.5% at follow-up) and CBT-E (22.5% at both EOT and follow-up) were not significantly different.;
Conclusions: ICAT was associated with significant improvements in bulimic and associated symptoms that did not differ from those obtained with CBT-E.
This initial randomized controlled trial of a new individual psychotherapy for BN suggests that targeting emotion and self-oriented cognition in the
context of nutritional rehabilitation may be efficacious and worthy of further study.;
Psychological Medicine, 44(3) : 543-
553
- Year: 2014
- Problem: Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Other Psychological Interventions
Poulsen, S., Lunn, S., Daniel, S. I. F., Folke, S., Mathiesen, B. B., Katznelson, H., Fairburn,
C.G.
Objective: The authors compared psychoanalytic
psychotherapy and cognitive-behavioral therapy (CBT) in the treatment of bulimia nervosa.; Method: A randomized controlled trial was conducted in
which 70 patients with bulimia nervosa received either 2 years of weekly psychoanalytic psychotherapy or 20 sessions of CBT over 5 months. The main
outcome measure was the Eating Disorder Examination interview, which was administered blind to treatment condition at baseline, after 5 months, and
after 2 years. The primary outcome analyses were conducted using logistic regression analysis.; Results: Both treatments resulted in improvement, but
a marked difference was observed between CBT and psychoanalytic psychotherapy. After 5 months, 42% of patients in CBT (N=36) and 6% of patients in
psychoanalytic psychotherapy (N=34) had stopped binge eating and purging (odds ratio=13.40, 95% confidence interval [CI]=2.45-73.42; p<0.01). At 2
years, 44% in the CBT group and 15% in the psychoanalytic psychotherapy group had stopped binge eating and purging (odds ratio=4.34, 95% CI=1.33-
14.21; p=0.02). By the end of both treatments, substantial improvements in eating disorder features and general psychopathology were observed, but in
general these changes took place more rapidly in CBT.; Conclusions: Despite the marked disparity in the number of treatment sessions and the duration
of treatment, CBT was more effective in relieving binging and purging than psychoanalytic psychotherapy and was generally faster in alleviating
eating disorder features and general psychopathology. The findings indicate the need to develop and test a more structured and symptom-focused
version of psychoanalytic psychotherapy for bulimia nervosa.;
The American Journal of
Psychiatry, 171(1) : 109-116
- Year: 2014
- Problem: Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Psychodynamic/Psychoanalysis
Stein, K. F., Corte, C., Chen, D-
G. D., Nuliyalu, U., Wing, J.
Objective: Findings of a randomized trial of an identity intervention programme (IIP) designed to
build new positive self-schemas that are separate from other conceptions of the self in memory as the means to promote improved health in women
diagnosed with eating disorders are reported.; Method: After baseline data collection, women with anorexia nervosa or bulimia nervosa were randomly
assigned to IIP (n?=?34) or supportive psychotherapy (SPI) (n?=?35) and followed at 1, 6, and 12?months post-intervention.; Results: The IIP and
supportive psychotherapy were equally effective in reducing eating disorder symptoms at 1?month post-intervention, and changes were stable through
the 12-month follow-up period. The IIP tended to be more effective in fostering development of positive self-schemas, and the increase was stable
over time. Regardless of baseline level, an increase in the number of positive self-schemas between pre-intervention and 1-month post-intervention
predicted a decrease in desire for thinness and an increase in psychological well-being and functional health over the same period.; Discussion: A
cognitive behavioural intervention that focuses on increasing the number of positive self-schemas may be central to improving emotional health in
women with anorexia nervosa and bulimia nervosa.; Copyright © 2012 John Wiley & Sons, Ltd and Eating Disorders Association.
European Eating Disorders Review, 21(2) : 130-
142
- Year: 2013
- Problem: Eating Disorders
(any), Anorexia Nervosa, Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Supportive
therapy, Other Psychological Interventions
Wagner, G., Penelo, E., Nobis, G., Mayerhofer, A., Schau, J., Spitzer, M., Imgart, H., Karwautz, A.
Summary: Objective: This study aims to evaluate
the long-term outcome of new technology assisted guided self-help in adolescents with bulimia nervosa (BN). Method: One hundred and twenty-six
patients with BN (29 adolescents and 97 adults) were randomly allocated to a cognitive behavioural therapy-based self-help program delivered by the
Internet or bibliotherapy, both accompanied by e-mail guidance. Outcomes were assessed at baseline, month 4, 7 and 18 including remission rates and
eating disorder associated psychopathology. Results: In all, 44 % of adolescents vs. 38.7 % of adults were in remission at month 7, and 55 % of
adolescents vs. 62.5 % of adults were in remission at follow-up. Objective binge eating and compensatory behaviour improved significantly over time
in both groups, with the highest decrease during the first 4 months. A significant decrease over time and no group differences have been found in
almost all EDI-2 subscales. Conclusions: E-mail guided self-help (delivered via the Internet or bibliotherapy) is equally effective for adolescents
as for adults with BN, and can be recommended as an initial step of treatment for this younger age group. (copyright) 2013 Springer-Verlag Wien.
Neuropsychiatrie, 27(2) : 66-73
- Year: 2013
- Problem: Eating Disorders
(any), Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Self-help, Technology, comparing delivery mode (e.g. online vs. face-to-face)
Wagner, G., Penelo, E., Wanner, C., Gwinner, P., Trofaier, M-L., Imgart, H., Waldherr, K., Wober-Bingol, C., Karwautz, A. F. K.
Background: Cognitive-behavioural therapy (CBT)-based guided self-help is recommended as a first step
in the treatment of bulimia nervosa.; Aims: To evaluate in a randomised controlled trial (Clinicaltrials.gov registration number: NCT00461071) the
long-term effectiveness of internet-based guided self-help (INT-GSH) compared with conventional guided bibliotherapy (BIB-GSH) in females with
bulimia nervosa.; Method: A total of 155 participants were randomly assigned to INT-GSH or BIB-GSH for 7 months. Outcomes were assessed at baseline,
month 4, month 7 and month 18.; Results: The greatest improvement was reported after 4 months with a continued reduction in eating disorder
symptomatology reported at month 7 and 18. After 18 months, 14.6% (n = 7/48) of the participants in the INT-GSH group and 25% (n = 7/28) in the BIB-
GSH group were abstinent from binge eating and compensatory measures, 43.8% (n = 21/48) and 39.2% (n = 11/28) respectively were in remission. No
differences regarding outcome between the two groups were found.; Conclusions: Internet-based guided self-help for bulimia nervosa was not superior
compared with bibliotherapy, the gold standard of self-help. Improvements remain stable in the long term.;
British Journal of Psychiatry, 202 : 135-
141
- Year: 2013
- Problem: Bulimia Nervosa, Eating disorders not specified
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Self-help, Technology, interventions delivered using technology (e.g. online, SMS)
Stiles-Shields, Colleen, Hoste, Renee Rienecke, Doyle, Peter M., le Grange, Daniel
This review focuses on the use of family-based treatment (FBT)
for adolescents with eating disorders, including anorexia nervosa (AN) and bulimia nervosa (BN). AN and BN are serious disorders with significant
psychiatric and medical morbidity. Data support the use of family treatments for adolescents with eating disorders. Developed at the Maudsley
Hospital, FBT is a theoretically agnostic approach that externalizes the illness from the patient and empowers families to actively work to bring
about recovery in their relative with an eating disorder. FBT appears to be an effective treatment for adolescents with AN and support is developing
for the treatment of adolescents with BN. Manual development is currently underway for the implementation of FBT for young adults with eating
disorders, overweight adolescents, and those with subsyndromal AN. Further research is needed to determine the effectiveness of FBT with other
populations. In this review, we will provide a critical overview of the literature by focusing upon empirical findings regarding FBT, with particular
emphasis on studies conducted with adolescents.;
Reviews on
Recent Clinical Trials, 7(2) : 133-140
- Year: 2012
- Problem: Eating Disorders
(any), Anorexia Nervosa, Bulimia Nervosa
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Family therapy