Special Section Article

Bulimia nervosa treatment: A systematic review of randomized controlled trials†

  1. Jennifer R. Shapiro PhD1,
  2. Nancy D. Berkman PhD2,
  3. Kimberly A. Brownley PhD1,
  4. Jan A. Sedway PhD1,
  5. Kathleen N. Lohr PhD2,
  6. Cynthia M. Bulik PhD1,3,*

Article first published online: 16 MAR 2007

DOI: 10.1002/eat.20372

Issue

International Journal of Eating Disorders

International Journal of Eating Disorders

Volume 40, Issue 4, pages 321–336, May 2007

Additional Information

How to Cite

Shapiro, J. R., Berkman, N. D., Brownley, K. A., Sedway, J. A., Lohr, K. N. and Bulik, C. M. (2007), Bulimia nervosa treatment: A systematic review of randomized controlled trials. International Journal of Eating Disorders, 40: 321–336. doi: 10.1002/eat.20372

Author Information

  1. 1

    Department of Psychiatry, University of North Carolina at Chapel Hill, North Carolina

  2. 2

    RTI International, Research Triangle Park, North Carolina

  3. 3

    Department of Nutrition, University of North Carolina at Chapel Hill, North Carolina

*Department of Psychiatry, University of North Carolina at Chapel Hill, 101 Manning Drive, CB #7160, Chapel Hill, NC 27599-7160

  1. †

    The authors of this report are responsible for its content. Statements in the report should not be construed as endorsement by the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services of a particular drug, device, test, treatment, or other clinical service.

Publication History

  1. Issue published online: 28 MAR 2007
  2. Article first published online: 16 MAR 2007
  3. Manuscript Accepted: 2 JAN 2007

Funded by

  • Agency for Healthcare Research and Quality. Grant Number: 290-02-0016
  • RTI International-University of North Carolina Evidence-based Practice Center

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Keywords:

  • bulimia nervosa;
  • eating disorders;
  • clinical trials;
  • evidence based review;
  • purging;
  • eating disorder inventory;
  • cognitive behavioral therapy;
  • behavioral intervention trials;
  • second-generation antidepressants

Abstract

Objective:

The RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center systematically reviewed evidence on efficacy of treatment for bulimia nervosa (BN), harms associatedwith treatments, factors associated with treatment efficacy, and differential outcome by sociodemographic characteristics.

Method:

We searched six major databases published from 1980 to September 2005 in all languages against a priori inclusion/exclusion criteria; we focused on eating, psychiatric or psychological, and biomarker outcomes.

Results:

Forty-seven studies of medication only, behavioral interventions only, and medication plus behavioral interventions for adults or adolescents met our inclusion criteria. Fluoxetine (60 mg/day) decreases the core symptoms of binge eating and purging and associated psychological features in the short term. Cognitive behavioral therapy reduces core behavioral and psychological features in the short and long term.

Conclusion:

Evidence for medication or behavioral treatment for BN is strong, for self-help is weak; for harms related to medication is strong but either weak or nonexistent for other interventions; and evidence for differential outcome by sociodemographic factors is nonexistent. Attention to sample size, standardization of outcome measures, attrition, and reporting of abstinence from target behaviors are required. Longer follow-up intervals, innovative treatments, and attention to sociodemographic factors would enhance the literature. © 2007 by Wiley Periodicals, Inc. Int J Eat Disord 2007

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