Pure and guided self-help for full and sub-threshold bulimia nervosa and binge eating disorder


Department of Psychology, Box 1225, SE-751 42 Uppsala, Sweden (e-mail: ata.ghaderi@psyk.uu.se).


Objective:The study compared the efficacy of self-help without and with guidance (referred to as ‘pure’ and ‘guided’ self-help), using a cognitive behavioral self-help manual (Fairburn, 1995) for binge eating.

Design and methods:A sample of 31 participants with bulimia nervosa, subthreshold bulimia nervosa and binge-eating disorder were assigned randomly to one of the self-help levels for 16 weeks, after four weeks of baseline observations.

Results:The results indicated that both forms of self-help treatments had a modestly positive and sustained effect on the participants' eating problems. Intention-to-treat analyses showed that participants reduced their mean number of objective bulimic episodes and purging behaviour by 33% and 17% over the course of the treatment. The corresponding reduction levels for the treatment completers (N = 18) were 58% and 61%, respectively. Furthermore, there were no significant differences between the pure and guided self-help groups in terms of outcome, reflecting the probable insignificance of guidance for the broader group of individuals with binge-eating problems. At follow-up, no further significant improvement or deterioration was observed in the ensuing six months compared with the post-treatment data.

Conclusion:Given the heterogeneity of the diagnostic groups in the present study, resulting in high external validity, and the conservative nature of the analyses, self-help is discussed as a viable means of initial treatment for binge eating.