Disorders - Bulimia Nervosa
Kaslow, Nadine J., Broth, Michelle Robbins, Smith, Chaundrissa Oyeshiku, Collins, Marietta
H.
Emotional and behavioral symptoms and disorders are prevalent in children and adolescents. There
has been a burgeoning literature supporting evidence-based treatments for these disorders. Increasingly, family-based interventions have been gaining
prominence and demonstrating effectiveness for myriad childhood and adolescent disorders. This article presents the current evidence in support of
family-based interventions for mood, anxiety, attention-deficit hyperactivity, disruptive behavior, pervasive developmental particularly autism
spectrum, and eating disorders. This review details recent data from randomized controlled trials (RCTs) and promising interventions not yet examined
using a randomized controlled methodology. It highlights the evidence base supporting various specific family-based interventions, some of which are
disorder dependent. A practitioner perspective is then offered with regard to recommendations for future practice and training. The article closes
with a summary and directions for future research.; © 2012 American Association for Marriage and Family Therapy.
Journal of Marital & Family Therapy, 38(1) : 82-
100
- Year: 2012
- Problem: Anxiety Disorders (any), Depressive Disorders, Anorexia Nervosa, Bulimia Nervosa
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Family therapy
Flament, Martine F., Bissada,
Hany, Spettigue, Wendy
The objective was to review scientific evidence for efficacy
and safety of pharmacotherapy in adults or children with an eating disorder (ED). We conducted a computer search for all randomized controlled trials
(RCTs) published between 1960 and May 2010 for treatment of anorexia nervosa (AN), bulimia nervosa (BN) or binge-eating disorder (BED). For drugs for
which no RCT was found, open trials or case reports were retrieved. Clinically relevant RCTs in the treatment of AN have used atypical
antipsychotics, selective serotonin reuptake inhibitors (SSRIs), and zinc supplementation. Olanzapine demonstrated an adjunctive effect for in-
patient treatment of underweight AN patients, and fluoxetine helped prevent relapse in weight-restored AN patients in 1/2 studies. For treatment of
BN, controlled studies have used SSRIs, other antidepressants, and mood stabilizers. In 9/11 studies, pharmacotherapy yielded a statistically
significant although moderate reduction in binge/purge frequency, and some additional benefits. For BED, RCTs have been conducted using SSRIs and one
serotonin norepinephrine reuptake inhibitor (SNRI), mood stabilizers, and anti-obesity medications. In 11/12 studies, there was a statistically
significant albeit limited effect of medication. Meta-analyses on efficacy of pharmacotherapy for BN and BED support moderate effect sizes for
medication, but generally low recovery rates. Treatment resistance is an inherent feature of AN, where treatment should focus on renourishment plus
psychotherapy. For BN and BED, combined treatment with pharmacotherapy and cognitive behaviour therapy has been more effective than either alone.
Data on the long-term efficacy of pharmacotherapy for EDs are scarce. Short- and long-term pharmacotherapy of EDs still remains a challenge for the
clinician.;
International Journal of Neuropsychopharmacology, 15(2) : 189-
207
- Year: 2012
- Problem: Anorexia Nervosa, Binge Eating Disorders, Bulimia Nervosa
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any)
Hill, D. M., Craighead, L. W., Safer, D. L.
Objective: This treatment development study investigated the acceptability and efficacy of a
modified version of dialectical behavior therapy (DBT) for bulimia nervosa (BN), entitled appetite focused DBT (DBT-AF). Method: Thirty-two women
with binge/purge episodes at least one time per week were randomly assigned to 12 weekly sessions of DBT-AF (n = 18) or to a 6-week delayed treatment
control (n = 14). Participants completed the EDE interview and self-report measures at baseline, 6 weeks, and posttreatment. Results: Treatment
attrition was low, and DBT-AF was rated highly acceptable. At 6 weeks, participants who were receiving DBT-AF reported significantly fewer BN
symptoms than controls. At posttest, 26.9% of the 26 individuals who entered treatment (18 initially assigned and 8 from the delayed treatment
control) were abstinent from binge/purge episodes for the past month; 61.5% no longer met full or subthreshold criteria for BN. Participants
demonstrated a rapid rate of response to treatment and achieved clinically significant change. Discussion: Results suggest that DBT-AF warrants
further investigation as an alternative to DBT or cognitive behavior therapy for BN. (copyright) 2010 by Wiley Periodicals, Inc.
International Journal of Eating Disorders, 44(3) : 249-
261
- Year: 2011
- Problem: Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Dialectical behavioural therapy
(DBT)
Mitchell, J. E., Agras, S., Crow, S., Halmi, K., Fairburn, C. G., Bryson, S., Kraemer, H.
Background: This study compared the best available treatment for bulimia nervosa,
cognitive-behavioural therapy (CBT) augmented by fluoxetine if indicated, with a stepped-care treatment approach in order to enhance treatment
effectiveness. Aims: To establish the relative effectiveness of these two approaches. Method: This was a randomised trial conducted at four clinical
centres (Clinicaltrials.gov registration number: NCT00733525). A total of 293 participants with bulimia nervosa were randomised to one of two
treatment conditions: manual- based CBT delivered in an individual therapy format involving 20 sessions over 18 weeks and participants who were
predicted to be non-responders after 6 sessions of CBT had fluoxetine added to treatment; or a stepped-care approach that began with supervised
self-help, with the addition of fluoxetine in participants who were predicted to be non-responders after six sessions, followed by CBT for those who
failed to achieve abstinence with self-help and medication management. Results: Both in the intent-to-treat and completer samples, there were no
differences between the two treatment conditions in inducing recovery (no binge eating or purging behaviours for 28 days) or remission (no longer
meeting DSM-IV criteria). At the end of 1-year follow-up, the stepped-care condition was significantly superior to CBT. Conclusions: Therapist-
assisted self-help was an effective first-level treatment in the stepped-care sequence, and the full sequence was more effective than CBT suggesting
that treatment is enhanced with a more individualised approach.
British Journal of Psychiatry, 198(5) : 391-
397
- Year: 2011
- Problem: Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs), Service Delivery & Improvement, Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Self-help, Other service delivery and improvement
interventions
Stiles-Shields, C., Smyth, A., Glunz, C., Hoste, R. R., Boepple, L., le Grange, D.
Eating disorders frequently have their onset in adolescence. This is problematic as
Anorexia Nervosa (AN), Bulimia Nervosa (BN), and Eating Disorder Not Otherwise Specified (EDNOS) often present with serious psychiatric and medical
sequelae that can affect an adolescent's physical and emotional development. It is well documented that complications from eating disorders in
adolescence can result in long-term health consequences, rendering effective psychiatric and medical treatments a necessity. To combat the medical
consequences associated with eating disorders in adolescents, pediatricians must identify, treat, and monitor medical complications. Pediatricians
are also responsible for assessing the need for hospitalization due to medical instability. Some advances have been made regarding
psychopharmacological treatments for eating disorders. For example, antidepressant medications, such as SSRIs, have demonstrated efficacy in the
treatment of adults with BN. The true effectiveness of these medications in adolescent populations remains unknown. A multidisciplinary team approach
is a common treatment model in outpatient practice, but further research is required to investigate how to facilitate the collaboration of
psychiatric and medical professionals. The majority of psychiatric and medical trials for eating disorder patients have involved adult participants,
and most studies have investigated either psychiatric or medical treatments for eating disorders. In this review, we will add to the current
literature by focusing on both psychiatric and medical treatments for eating disorders, with particular emphasis on studies conducted with
adolescents. (copyright) 2011 Bentham Science Publishers.
Current Psychiatry Reviews, 7(3) : 177-
188
- Year: 2011
- Problem: Anorexia Nervosa, Bulimia Nervosa, Eating disorders not specified
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any)
Sanchez-Ortiz, V. C., Munro, C., Stahl, D., House, J., Startup, H., Treasure, J., Williams, C., Schmidt, U.
Bulimic eating disorders are common among female students, yet
the majority do not access effective treatment. Internet-based cognitive-behavioural therapy (iCBT) may be able to bridge this gap. Seventy-six
students with bulimia nervosa (BN) or eating disorder not otherwise specified (EDNOS) were randomly assigned to immediate iCBT with e-mail support
over 3 months or to a 3-month waiting list followed by iCBT [waiting list/delayed treatment control (WL/DTC)]. ED outcomes were assessed with the
Eating Disorder Examination (EDE) at baseline, 3 months and 6 months. Other outcomes included depression, anxiety and quality of life. Students who
had immediate iCBT showed significantly greater improvements at 3 and 6 months than those receiving WL/DTC in ED and other symptoms. iCBT with e-mail
support is efficacious in students with bulimic disorders and has lasting effects.
Psychological Medicine, 41(2) : 407-
417
- Year: 2011
- 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), Cognitive & behavioural therapies (CBT), Technology, interventions delivered using technology (e.g. online, SMS)
Katzman, Melanie A., Bara-Carril, Nuria, Rabe-
Hesketh, Sophia, Schmidt, Ulrike, Troop, Nicholas, Treasure, Janet
Objective: Methods: Results: Conclusions:
To conduct a randomized, controlled, two-stage trial in the treatment of bulimia nervosa, comparing cognitive-behavioral therapy (CBT) versus
motivational enhancement in Phase 1 followed by group versus individual CBT in Phase 2.A total of 225 patients with bulimia nervosa or eating
disorder not otherwise specified (EDNOS) were recruited into a randomized controlled trial lasting 12 weeks with follow-ups at 1 year and 2.5
years.Patients improved significantly across all of the interventions with no differences in outcome or treatment adherence. Including motivational
enhancement therapy rather than a CBT first phase of treatment did not affect outcome.Outcome differences between individual and group CBT were
minor, suggesting that group treatment prefaced by a short individual intervention may be a cost-effective alternative to purely individual
treatment.
Psychosomatic Medicine, 72(7) : 656-
663
- Year: 2010
- Problem: Bulimia Nervosa, Eating disorders not specified
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Motivational interviewing, includes Motivational Enhancing Therapy
Fogarty,
S., Harris, D., Zaslawski, C., McAinch, A. J., Stojanovska, L.
Objective: This study
examines the role of acupuncture as an adjunct therapy in the treatment of eating disorders in female patients. Design: A randomised cross-over study
was used in this study. The two treatments phases were the private multi-disciplinary outpatient eating disorder facility in Melbourne, Australia,
only (referred to as their treatment as usual) and a continuation of their treatment as usual supplemented by acupuncture. Participants: Patients
receiving treatment at a private multi-disciplinary outpatient eating disorder facility in Melbourne, Australia were asked to participate in the
study. Nine consenting women (5 with Anorexia Nervosa, 4 with Bulimia Nervosa), aged (mean and SD) 23.7 (9.6) years, participated in the study. Main
outcome measures: The main outcome measure was the Eating Disorder Inventory-3. Secondary outcome measures were the Becks Depression Inventory-2,
State Trait Anxiety Inventory and the Eating Disorder Quality of Life Scale. Results: There was evidence that acupuncture improved the participants'
Quality of Life as measured by the physical/cognitive and psychological components of the Eating Disorder Quality of Life scale. There was also
evidence of decreases in anxiety (both State and Trait as measured by the State Trait Anxiety Intervention) and perfectionism (as measured by the
Eating Disorder Inventory-3). Conclusion: This pilot study shows potential of the benefit of acupuncture as an adjunct therapy in the treatment of
eating disorders particularly in the area of quality of life. (copyright) 2010.
Complementary Therapies in Medicine, 18(6) : 233-240
- Year: 2010
- Problem: Anorexia Nervosa, Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Acupuncture, acupressure
Carei, T. Rain, Fyfe-Johnson, Amber L., Breuner, Cora C., Brown,
Margaret A.
Purpose: Methods: Results: Conclusions: This was a pilot project designed to assess the effect of
individualized yoga treatment on eating disorder outcomes among adolescents receiving outpatient care for diagnosed eating disorders (anorexia
nervosa, bulimia nervosa, eating disorder not otherwise specified).A total of 50 girls and 4 boys aged 11-21 years were randomized to an 8-week trial
of standard care vs. individualized yoga plus standard care. Of these, 27 were randomized to standard care and 26 to yoga plus standard care
(attrition: n = 4). Standard care (every other week physician and/or dietician appointments) was required to meet ethical guidelines. The No Yoga
group was offered yoga after study completion as an incentive to maintain participation. Outcomes evaluated at baseline, end of trial, and 1-month
follow-up included Eating Disorder Examination (EDE), Body Mass Index (BMI), Beck Depression Inventory, State-Trait Anxiety Inventory, and Food
Preoccupation questionnaire.The Yoga group demonstrated greater decreases in eating disorder symptoms. Specifically, the EDE scores decreased over
time in the Yoga group, whereas the No Yoga group showed some initial decline but then returned to baseline EDE levels at week 12. Food preoccupation
was measured before and after each yoga session, and decreased significantly after all sessions. Both groups maintained current BMI levels and
decreased in anxiety and depression over time.Individualized yoga treatment decreased EDE scores at 12 weeks, and significantly reduced food
preoccupation immediately after yoga sessions. Yoga treatment did not have a negative effect on BMI. Results suggest that individualized yoga therapy
holds promise as adjunctive therapy to standard care.; Copyright 2010 Society for Adolescent Medicine. Published by Elsevier Inc. All rights
reserved.
Journal of Adolescent Health, 46(4) : 346-351
- Year: 2010
- Problem: Anorexia Nervosa, Bulimia Nervosa, Eating disorders not specified
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Mind-body exercises (e.g. yoga, tai chi, qigong)
Fernandez-Aranda, Fernando, Nunez,, Araceli, Krug, Isabel, Cappozzo, Mikael, Carrard, Isabelle, Rouget,
Patrick, Jimenez-Murcia, Susana, Granero, Roser, Penelo, Eva, Lam, Tony
The object of this study was to examine the effectiveness of an Internet-based therapy (IBT) for bulimia nervosa (BN) as
compared to a waiting list (WL). Sixty-two female BN patients, diagnosed according to DSM-IV criteria, were assigned to either the IBT or a WL. The
control participants (WL) were matched to the IBT group in terms of age, duration of the disorder, number of previous treatments, and severity of the
disorder. Assessment measures included the EDI, SCL-90-R, BITE, the TCI-R, and other clinical and psychopathological indices, which were
administrated before and after the treatment. Considering the IBT, while the mean scores were lower at the end of the treatment for some EDI scales
(bulimic, interpersonal distrust, maturity fears, and total score) and the BITE symptomatology subscale, the mean BMI was higher at post therapy.
Predictors of good IBT outcome were higher scores on the EDI perfectionism scale and EAT and a higher minimum BMI. Dropout (after IBT 35.5% of cases)
was related to higher SCL-anxiety scores, a lower hyperactivity, a lower minimum BMI, and lower TCI-reward dependence scores. At the end of the
treatment, bingeing and vomiting abstinence rates differed significantly between the two groups. Results suggest that an online self-help approach
appears to be a valid treatment option for BN when compared to a WL control group, especially for people who present a lower severity of their eating
disorder (ED) symptomatology and some specific personality traits. (PsycINFO Database Record (c) 2010 APA, all rights reserved) (journal
abstract)
CyberPsychology & Behavior, 12(1) : 37-
41
- Year: 2009
- Problem: Bulimia Nervosa
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Technology, interventions delivered using technology (e.g. online, SMS)
Korrelboom, Kees, de Jong, Martie, Huijbrechts, Irma, Daansen, Peter
This study
evaluates a short stepwise cognitive-behavioral intervention for the treatment of low self-esteem in patients with eating disorders. Competitive
memory training (COMET) for low self-esteem is based on insights and findings from experimental psychology. A total of 52 patients with eating
disorders and low self-esteem were treated with COMET in a routine mental health center in addition to their regular treatment. These patients were
randomized to receive 8 weeks of COMET + therapy as usual (TAU) or to receive TAU only. Differential effects in favor of COMET + TAU were found for 2
indexes of self-esteem and for 1 index of depressive mood. Shortcomings of this study and possible clinical implications are discussed.; (c) 2009
APA, all rights reserved.
Journal of Consulting & Clinical
Psychology, 77(5) : 974-980
- Year: 2009
- Problem: Anorexia Nervosa, Bulimia Nervosa, Eating disorders not specified
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Zeeck,
Almut, Weber, Stefanie, Sandholz, Angelika, Wetzler-Burmeister, Edda, Wirsching, Michael, Hartmann,
Armin
Background: Method: Results: Conclusions: In bulimia nervosa, more intense treatments are
recommended if outpatient treatment fails. This is the first randomized controlled trial comparing the options of inpatient versus day clinic
treatment.Patients with severe bulimia nervosa were randomly assigned to inpatient or day clinic treatment of similar length and intensity. Specific
and general psychopathology was assessed at the end of treatment and a 3-month follow-up.Fifty-five patients were randomized; 22 day clinic patients
and 21 inpatients started the program. At the end of treatment, a significant reduction of general and specific pathology was found in both settings.
Following discharge, there was more deterioration in bulimic symptoms after inpatient treatment, but overall, results were comparable.Inpatient and
day clinic programs are effective treatments for severely disturbed bulimic patients with similar results at the 3-month follow-up. Further follow-up
will show if a higher instability of results after inpatient treatment is of importance in the long term.; Copyright (c) 2009 S. Karger AG,
Basel.
Psychotherapy &
Psychosomatics, 78(3) : 152-160
- Year: 2009
- Problem: Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement
interventions