• bulimia nervosa;
  • cognitive behavioral therapy;
  • eating attitudes



This study examined the eating attitudes that are associated with a reduction in bulimic behaviors during the key early stage of cognitive behavioral therapy (CBT).


A case series of 41 patients with bulimia nervosa (full or partial syndrome) took part. They were drawn from the case loads of CBT therapists working in an outpatient specialist eating disorders team. Each patient completed the Eating Disorder Examination-Questionnaire and recorded the frequency of objective binges, the frequency of vomiting and the number of laxatives taken between Sessions 1 and 6.


The participants' reduction in behaviors suggested that the early part of CBT was effective. Correlational analyses showed that those with poorer eating attitudes at the outset of therapy were likely to show the greatest behavioral change by Session 6, in keeping with findings relating to the full duration of CBT.


Patients with relatively unhealthy eating attitudes are more likely to show positive behavioral change in the early part of course of CBT. Clinicians might need to encourage patients with bulimic disorders to work harder on behavioral change when the individual has less pathological eating attitudes at the outset. © 2011 by Wiley Periodicals, Inc.