Chapter

Bulimia

Child and Adolescent Disorders

II. Specific Disorders

  1. Ata Ghaderi

Published Online: 25 JUN 2012

DOI: 10.1002/9781118156391.ebcp001026

Handbook of Evidence-Based Practice in Clinical Psychology

Handbook of Evidence-Based Practice in Clinical Psychology

How to Cite

Ghaderi, A. 2012. Bulimia. Handbook of Evidence-Based Practice in Clinical Psychology. 1:II:26.

Publication History

  1. Published Online: 25 JUN 2012

Abstract

Bulimia nervosa (BN), characterized by overevaluation of control over eating, shape, and weight, as well as recurrent binge eating and compensatory behaviors (e.g., self-induced vomiting, abuse of laxatives, excessive training, or fasting) was entered in the DSM in 1980. Bulimia nervosa is more common among women than men, with usual onset between mid- and late teenage years. It is a severe and relatively chronic condition. Using different definitions of outcome, full recovery seems to range from 38% to 47%, 10 years after the presentation. Fortunately, several evidence-based treatments are available. Meta-analysis, systematic reviews, and practice guidelines, together with evidence from most recent studies in the field, suggest cognitive behavior therapy (CBT) as a first-line treatment of choice for BN. More recent data corroborates the conclusions regarding CBT-based self-help as a viable first step in the treatment of BN. Patients can also be offered a trial of an antidepressant drug. They should be informed, however, that the long-term effects are unknown, that the risk of relapse is higher in medication than psychological treatments, and that any beneficial effects will be rapidly apparent. Accumulated evidence also suggests that Interpersonal Psychotherapy adapted for BN could be viewed as an alternative to CBT, but the patients should be informed that it takes up to 12 months to achieve results comparable to CBT. The treatment of the majority of patients with BN should be conducted in an outpatient setting. More research is needed on the efficacy of alternative psychological treatments, as well as improving the maintenance of treatment effects with regard to psychoactive medication. CBT and IPT need to be enhanced. Dissemination and cost-effectiveness are other areas in need of further research.

Keywords:

  • evidence-based treatment;
  • bulimia;
  • cognitive behavior therapy;
  • interpersonal psychotherapy;
  • pharmacological treatments;
  • dissemination;
  • psychotherapy outcome