Disorders - Bulimia Nervosa
Treasure, J., Schmidt, U., Troop, N., Tiller, J., Todd, G., Keilen,
M., Dodge, E.
Objective - To test the short term efficacy of a self directed treatment manual for bulimia nervosa. Design - Randomised controlled
trial of the manual against cognitive behavioural therapy and a waiting list. Setting - Tertiary referral centre. Subjects - 81 consecutive referrals
presenting with bulimia nervosa or atypical bulimia nervosa. Main outcome measures - Frequency of binge eating, vomiting, and other behaviours to
control weight as ell as abstinence from these behaviours. Results - Cognitive behavioural treatment produced a significant reduction in the
frequency of binge eating, vomiting, and other behaviours to control weight. The manual significantly reduced frequency of binge eating and weight
control behaviours other than vomiting, and there was no change in the group on the waiting list. Full remission was achieved in five (24%) of the
group assigned to cognitive behavioural treatment, nine (22%) of the group who used the manual, and two (11%) of the group on the waiting list.
Conclusions - A self directed treatment manual may be a useful first intervention in the treatment of bulimia nervosa.
British Medical Journal., 308(6930) : 686-689
- Year: 1994
- 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), Self-help
Garner, D. M., Rockert, W., Davis, R., Garner, M. V., Olmsted, M. P., Eagle, M.
Objective: The authors compared the effectiveness of 4 months (18 sessions) of cognitive-behavioral and supportive-expressive therapy
for bulimia. Method: Sixty patients obtained from clinical referrals to an eating disorders program who met modified DSM-III-R criteria for bulimia
nervosa were randomly assigned to the two conditions. Treatments were delivered in an individual format, on an outpatient basis, by experienced
therapists using treatment manuals. The primary outcome measures were self-induced vomiting, binge eating, and attitudes toward body weight and
shape, which were assessed by self-report and structured interview. Results: Fifty patients completed treatment, 25 in each condition. Both
treatments led to significant improvements in specific eating disorder symptoms and in psychosocial disturbances. Supportive-expressive therapy was
just as effective as cognitive-behavioral therapy in reducing binge eating. Where treatment differences were found, they favored cognitive-behavioral
therapy. Cognitive- behavioral therapy was marginally superior in reducing the frequency of self- induced vomiting; 36% of the patients who received
cognitive-behavioral therapy and 12% of those who received supportive-expressive therapy abstained from vomiting in the last month of treatment.
Cognitive-behavioral therapy was significantly more effective in ameliorating disturbed attitudes toward eating and weight, depression, poor self-
esteem, general psychological distress, and certain personality traits. Conclusions: These results moderately favor cognitive-behavioral therapy over
supportive-expressive therapy for bulimia nervosa, but follow-up is required to determine the durability of outcome with both modalities. The
findings must be interpreted with caution since the selected clinical sample in this study may not represent the bulimia nervosa population.
American
Journal of Psychiatry., 150(1) : 37-46
- Year: 1993
- Problem: Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Supportive
therapy
Kennedy, SH., Goldbloom, D., Ralevski, E., Davis, C., et al.,
Evaluated the effect
of brofaromine (BFM) on measures of eating behavior and attitudes toward weight and shape, as well as concomitant psychopathology, in a group of 36
women (aged 18-40 yrs) with bulimia nervosa. 19 Ss were randomly assigned to the drug group, and 17 Ss were assigned to the placebo group for an 8-wk
outpatient trial. BFM produced a significant effect in decreasing episodes of vomiting throughout the trial, although comparable reductions in binge
eating were found in both groups. Also, there were no advantages of drug over placebo on improvements in attitudinal measures and shape or non-self-
report ratings of depression and anxiety. However, a significant proportion of the Ss on BFM lost weight when compared with the placebo group.
(PsycINFO Database Record (c) 2008 APA, all rights reserved).
Journal of Clinical
Psychopharmacology, 13(6) : 415-422
- Year: 1993
- Problem: Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Monoamine oxidase inhibitors (MAOIs) & ARIMAs
Fahy, T. A., Eisler,
I., Russell, G. F. M.
d-Fenfluramine is a 5-HT agonist which decreases food intake and
excessive carbohydrate intake in humans. A placebo-controlled trial of d-fenfluramine (45 mg/day) was conducted in 43 patients with bulimia nervosa.
The patients entered an eight-week trial of medication during which they also received cognitive-behavioural therapy. Treatment response was assessed
using food diaries to record eating behaviour, and self-rating questionnaires to measure psychopathology. The drug trial, and a follow-up assessment
after a further eight weeks, were completed by 39 patients. Abnormal eating behaviour and psychopathology improved significantly in both the d-
fenfluramine and placebo groups during the treatment trial. The study failed to show that the addition of d-fenfluramine affords an advantage over
brief psychotherapy alone. Although d-fenfluramine is effective in suppressing the overeating, excessive snacking, and excessive carbohydrate
consumption which are frequently found in overweight or obese patients, this study suggests that the drug is not an effective treatment for bulimia
nervosa.
British Journal of
Psychiatry., 162 : 597-603
- Year: 1993
- Problem: Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Appetite
moderators
Fairburn, C. G., Jones, R., Peveler, R. C., Hope, R. A., O'Connor,
M.
Objective: To determine whether cognitive behavior therapy (CBT) for bulimia nervosa has a specific
therapeutic effect and determine whether a simplified behavioral treatment (BT) of CBT is as effective as the full treatment. Design: Randomized
controlled trial involving three psychological treatments. Two planned comparisons. CBT with interpersonal psychotherapy (IPT), and CBT with BT.
Closed 12-month follow-up period. Independent assessors. Setting: Secondary referral center. Patients: Seventy-five consecutively referred patients
with bulimia nervosa. Patients with concurrent anorexia nervosa were excluded. Interventions: Cognitive behavior therapy, IPT, BT conducted on an
individual outpatient basis. There were nineteen sessions over 18 weeks. Six experienced therapists administered all three treatments. There was no
concurrent treatment. Main Outcome Measure: Frequency of binge eating and purging. Results: High rate (48%) of attrition and withdrawal among the
patients who received BT. Over follow-up, few patients undergoing BT met criteria for a good outcome (cessation of all forms of binge eating and
purging). Patients in the CBT and IPT treatments made equivalent, substantial, and lasting changes across all areas of symptoms, although there were
clear temporal differences in the pattern of response, with IPT taking longer to achieve its effects. Conclusions: Bulimia nervosa may be treated
successfully without focusing directly on the patient's eating habits and attitudes to shape and weight. Cognitive behavior therapy and IPT achieved
equivalent effects through the operation of apparently different mediating mechanisms. A further comparison of CBT and IPT is warranted. The
behavioral version of CBT was markedly less effective than the full treatment.
Archives of General Psychiatry., 50(6) : 419-
428
- Year: 1993
- Problem: Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Interpersonal therapy (IPT)
Gendron, Mary, Lemberg, Raymond, Allender, James, Bohanske, Jacquie
Examined the impact of an intensive 2-day group treatment and follow-up session on
self-esteem, eating attitudes, and reduction of bingeing-purging behaviors. 24 women who met the Diagnostic and Statistical Manual of Mental
Disorders-III (DSM-III) criteria for bulimia and who binged-purged at least once per week participated in the study. Half the Ss were assigned to the
treatment group, the other half to the control group. Compared with the control group, Ss in the treatment group evidenced significant improvements
in self-esteem and severity of binge eating. The frequency of binge-purge episodes and dysfunctional eating attitudes were also significantly
reduced. Results suggest that the intensive group process-retreat model is an effective adjunct in the treatment of bulimia. (PsycINFO Database
Record (c) 2008 APA, all rights reserved).
Group, 16(2) : 69-78
- Year: 1992
- Problem: Bulimia Nervosa
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Fichter, Manfred M., Leibl,
K., Rief, W., Brunner, Evelyn, et al.,
In a double-blind trial, 40 patients with bulimia nervosa were randomly assigned
either to a 60 mg fluoxetine (FXT) group or to a placebo control group. FXT or placebo was given over a period of 35 days. Parallel to the drug
trial, Ss participated in an intensive inpatient behavioral psychotherapy program. FXT was well tolerated and had only minor adverse effects. In
self-ratings and expert ratings concerning attitudes toward eating, eating behavior, and general psychopathology, significant improvements over time
were observed in both groups. The intensive inpatient-care and psychotherapy program was highly effective in changing eating behavior and attitudes
as well as general psychopathology. FXT showed a significant reduction in body weight, especially during the 1st 3 wks of FXT treatment. (German
abstract) (PsycINFO Database Record (c) 2008 APA, all rights reserved).
Pharmacopsychiatry, 24(1) : 1-
7
- Year: 1991
- Problem: Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs)
Laessle, R., Beumont, P., Butow, P., Lennerts,
W., O'Connor, M., Pirke, K., Touyz, S., Waadt, S.
In a comparison of nutritional management (NM) and stress management (SM) for
treatment of bulimia nervosa, 55 female patients (mean age 23.8 yrs) were randomly assigned to either treatment. Therapy consisted of 15 sessions in
a group over three months, by the end of which, patients under both treatment conditions showed a significant reduction in the frequency of binge
eating and vomiting and a significant improvement in various psychopathological features such as body dissatisfaction and depression. All
improvements were maintained over 12-month follow- up. NM produced a more rapid improvement in general eating behaviour, a faster reduction in binge
frequency and a higher abstinence rate from binge eating. SM led to greater positive changes in certain psychopathological features such as feelings
of ineffectiveness, interpersonal distrust and anxiety. NM should be regarded as a necessary first intervention in all bulimic patients. Further
psychological therapy, such as SM, is indicated as well for some patients, depending on their specific psychological difficulties. (PsycINFO Database
Record (c) 2008 APA, all rights reserved).
British Journal of Psychiatry, 159 : 250-261
- Year: 1991
- Problem: Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Psychological Interventions
(any), Other Psychological Interventions, Dietary advice, dietary change
Liedtke, R., Jager, B., Lempa, W., Kunsebeck, H. W., Grone, M., Freyberger, H.
Beyond the reduction of the core symptoms, different modification patterns are expected due to differing emphases
in two alternative types of treatment for bulimia nervosa: inpatient analytic and outpatient systemic therapy. The initial results of a study with a
waiting-list control group are reported. Eating disorders of the bulimic women definitely improved in both therapy groups, the results for the
inpatient group (n = 27) indicate a basic change in the attitude towards eating.
Psychotherapy & Psychosomatics., 56(1-2) : 56-
63
- Year: 1991
- Problem: Bulimia Nervosa
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Family therapy, Psychodynamic/Psychoanalysis
Hsu, L. K. G., Clement, L., Santhouse, R., Ju, E. S. Y.
Ninety-one female bulimic outpatients
received lithium carbonate or placebo on a random basis, after being separated into depressed and nondepressed subgroups, in an 8-week double-blind
trial. Sixty-eight patients who completed the study experienced a significant decrease in bulimic episodes after the 8 weeks. Lithium, in a dosage
yielding relatively low plasma levels, was not more effective than placebo. However, depression and other psychopathologies decreased with
improvement in bulimic behavior.
Journal of Nervous & Mental Disease., 179(6) : 351-
355
- Year: 1991
- Problem: Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Lithium
Walsh, B., Hadigan, Colleen M., Devlin, Michael J., Gladis, Madeline, et al.,
80 female patients (aged 18-45 yrs) with bulimia nervosa (BN) entered a 3-phase
treatment protocol to assess the efficacy of desipramine vs placebo in the treatment of BN. Binge frequency was assessed weekly by self-report
diaries. In the 8-wk initiation phase, the superiority of desipramine over placebo in reducing binge frequency was demonstrated. The use of
desipramine was also associated with significant reductions in other measures of behavioral and psychological disturbances characteristic of BN. Less
than half of the Ss treated with desipramine met criteria for entering the 16-wk maintenance phase, and 29% of the Ss relapsed in the following 4 mo.
There were not enough Ss in the discontinuation phase to permit clear conclusions about the need for continued antidepressant medication after 6 mo
of treatment. Data do not support the efficacy of long-term treatment with a single antidepressant for BN. (PsycINFO Database Record (c) 2008 APA,
all rights reserved).
American Journal of Psychiatry, 148(9) : 1206-
1212
- Year: 1991
- Problem: Bulimia Nervosa
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Tricyclic antidepressants
Wilson, G. T., Eldredge, K. L., Smith, D., Niles, B.
We compared cognitive-behavior therapy (CBT) with
and without exposure and response prevention (ERP) in the treatment of eating disorder patients who both binged and purged, and reported abnormal
attitudes concerning body weight and shape. Both treatments produced significant and comparable reductions in binge-eating and purging, eating
patterns, and attitudes about weight and shape at posttreatment. Treatment effects were generalized to improvements in different measures of general
psychopathology, and were maintained over follow-ups of 3 and 12 months. The findings are consistent with prior research showing that CBT is an
effective treatment for patients with the core features of bulimia nervosa. Furthermore, the data suggest that the addition of in-session exposure
and response prevention does not enhance the effectiveness of the basic CBT program.
Behaviour Research & Therapy., 29(6) : 575-
583
- Year: 1991
- Problem: Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Exposure therapy, Exposure
and response prevention