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Christopher G Fairburn - One of the best experts on this subject based on the ideXlab platform.
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a randomized controlled trial of psychoanalytic psychotherapy or cognitive behavioral therapy for Bulimia Nervosa
American Journal of Psychiatry, 2014Co-Authors: Stig Poulsen, Susanne Lunn, Sarah I F Daniel, Sofie Folke, Birgit Bork Mathiesen, Hannah Katznelson, Christopher G FairburnAbstract:Two years of psychoanalytic psychotherapy and 5 months of CBT with follow up visits for Bulimia Nervosa were compared. The proportions of patients who had stopped binging and purging at 2 years were 15% for psychoanalytic psychotherapy and 44% for CBT. Both treatments improve other eating disorder features and general psychopathology, but CBT does so faster, and therapists can learn CBT through videoconferencing.
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stepped care and cognitive behavioural therapy for Bulimia Nervosa randomised trial
British Journal of Psychiatry, 2011Co-Authors: James E Mitchell, Christopher G Fairburn, Scott J Crow, Katherine A Halmi, Stewart Agras, Susan W Bryson, Helena C KraemerAbstract:Background This study compared the best available treatment for Bulimia Nervosa, cognitive-behavioural therapy (CBT) augmented by fluoxetine if indicated, with a stepped-care treatment approach in order to enhance treatment effectiveness. Aims To establish the relative effectiveness of these two approaches. Method This was a randomised trial conducted at four clinical centres ([Clinicaltrials.gov][1] registration number: [NCT00733525][2]). A total of 293 participants with Bulimia Nervosa were randomised to one of two treatment conditions: manual-based CBT delivered in an individual therapy format involving 20 sessions over 18 weeks and participants who were predicted to be non-responders after 6 sessions of CBT had fluoxetine added to treatment; or a stepped-care approach that began with supervised self-help, with the addition of fluoxetine in participants who were predicted to be non-responders after six sessions, followed by CBT for those who failed to achieve abstinence with self-help and medication management. Results Both in the intent-to-treat and completer samples, there were no differences between the two treatment conditions in inducing recovery (no binge eating or purging behaviours for 28 days) or remission (no longer meeting DSM-IV criteria). At the end of 1-year follow-up, the stepped-care condition was significantly superior to CBT. Conclusions Therapist-assisted self-help was an effective first-level treatment in the stepped-care sequence, and the full sequence was more effective than CBT suggesting that treatment is enhanced with a more individualised approach. [1]: http://Clinicaltrials.gov [2]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT00733525&atom=%2Fbjprcpsych%2Fearly%2F2011%2F03%2F17%2Fbjp.bp.110.082172.atom
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prediction of outcome in Bulimia Nervosa by early change in treatment
American Journal of Psychiatry, 2004Co-Authors: Christopher G Fairburn, Terence G Wilson, Stewart W Agras, Timothy B Walsh, Eric SticeAbstract:OBJECTIVE: The authors’ goal was to identify predictors of treatment response in Bulimia Nervosa and, in particular, to attempt to replicate and extend the observation that early change predicts outcome. METHOD: Predictors of response at the end of treatment and 8-month follow-up were sought from a group of 220 women treated with either cognitive behavior therapy or interpersonal psychotherapy. RESULTS: Early change in frequency of purging was the best predictor of response at the end of treatment and at 8-month follow-up. CONCLUSIONS: Early change in treatment is a robust and potent predictor of immediate and longer-term outcome in Bulimia Nervosa.
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the natural course of Bulimia Nervosa and binge eating disorder in young women
Archives of General Psychiatry, 2000Co-Authors: Christopher G Fairburn, Zafra Cooper, Helen Doll, Patricia A Norman, Marianne E OconnorAbstract:Background: Little is known about the relative course and outcome of Bulimia Nervosa and binge eating disorder. Methods: Two community-based cohorts were studied prospectively over a 5-year year period. One comprised 102 participants with Bulimia Nervosa and the other 48 participants with binge eating disorder (21% [9/42] of whom had comorbid obesity). All participants were female and aged between 16 and 35 years at recruitment. The assessments were at 15-month intervals and addressed eating disorder features, general psychiatric symptoms, and social functioning. Results: Both cohorts showed marked initial improvement followed by gradual improvement thereafter. Between half and two thirds of the Bulimia Nervosa cohort had some form of eating disorder of clinical severity at each assessment point, although only a minority continued to meet diagnostic criteria for Bulimia Nervosa. Each year about a third remitted and a third relapsed. The outcome of the binge eating disorder cohort was better, with the proportion with any form of clinical eating disorder declining to 18% (7 of 40) by the 5-year follow-up. The relapse rate was low among this cohort. There was little movement of participants across the 2 diagnostic categories and few sought treatment. Both groups gained weight, with 39% of the binge eating disorder cohort (14 of 36) meeting criteria for obesity at 5-year follow-up. Conclusions: These findings suggest that, among young women in the community, Bulimia Nervosa and binge eating disorder have a different course and outcome. Whereas the prognosis of those with Bulimia Nervosa was relatively poor, the great majority of those with binge eating disorder recovered. Arch Gen Psychiatry. 2000;57:659-665
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a multicenter comparison of cognitive behavioral therapy and interpersonal psychotherapy for Bulimia Nervosa
Archives of General Psychiatry, 2000Co-Authors: Stewart W Agras, Terence G Wilson, Christopher G Fairburn, Timothy B Walsh, Helena C KraemerAbstract:Background Research suggests that cognitive-behavioral therapy (CBT) is the most effective psychotherapeutic treatment for Bulimia Nervosa. One exception was a study that suggested that interpersonal psychotherapy (IPT) might be as effective as CBT, although slower to achieve its effects. The present study is designed to repeat this important comparison. Method Two hundred twenty patients meeting DSM-III-R criteria for Bulimia Nervosa were allocated at random to 19 sessions of either CBT or IPT conducted over a 20-week period and evaluated for 1 year after treatment in a multisite study. Results Cognitive-behavioral therapy was significantly superior to IPT at the end of treatment in the percentage of participants recovered (29% [n=32] vs 6% [n=7]), the percentage remitted (48% [n=53] vs 28% [n=31]), and the percentage meeting community norms for eating attitudes and behaviors (41% [n=45] vs 27% [n=30]). For treatment completers, the percentage recovered was 45% (n=29) for CBT and 8% (n=5) for IPT. However, at follow-up, there were no significant differences between the 2 treatments: 26 (40%) CBT completers had recovered at follow-up compared with 17 (27%) IPT completers. Conclusions Cognitive-behavioral therapy was significantly more rapid in engendering improvement in patients with Bulimia Nervosa than IPT. This suggests that CBT should be considered the preferred psychotherapeutic treatment for Bulimia Nervosa.
Janet Treasure - One of the best experts on this subject based on the ideXlab platform.
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the use of a positive mood induction video clip to target eating behaviour in people with Bulimia Nervosa or binge eating disorder an experimental study
Appetite, 2019Co-Authors: Valentina Cardi, Jenni Leppanen, Monica Leslie, Mirko Esposito, Janet TreasureAbstract:Abstract Recent theoretical models and empirical research have indicated that momentary negative affect increases the likelihood of binge eating episodes for individuals with Bulimia Nervosa and binge eating disorder. However, relatively little research has explored the potential for positive mood to serve a protective effect in reducing the likelihood of overeating behaviour in Bulimia Nervosa and binge eating disorder. The current study included 30 women with Bulimia Nervosa or binge eating disorder in a within-subjects crossover design. Following exposure to a video designed to induce food craving, we found that a positive mood vodcast was associated with significantly lower levels of negative mood and food consumption in a taste test meal, when compared to a neutral vodcast (p = 0.002). These findings support a role for decreasing negative mood in reducing the likelihood of binge eating behaviour in women with Bulimia Nervosa and binge eating disorder.
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is attention to detail a similarly strong candidate endophenotype for anorexia Nervosa and Bulimia Nervosa
World Journal of Biological Psychiatry, 2013Co-Authors: Marion Roberts, Kate Tchanturia, Janet TreasureAbstract:Objectives. To investigate whether attention to detail is a similarly strong candidate endophenotype of anorexia (AN) and Bulimia Nervosa (BN), and to explore the incidence and clinical correlates ...
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a randomized controlled trial of family therapy and cognitive behavior therapy guided self care for adolescents with Bulimia Nervosa and related disorders
American Journal of Psychiatry, 2009Co-Authors: Ulrike Schmidt, Jennifer Beecham, Janet Treasure, Sarah E Perkins, Irene Yi, Suzanne Winn, Paul Robinson, Rebecca Murphy, Saskia Keville, Eric JohnsonsabineAbstract:Objective: To date no trial has focused on the treatment of adolescents with Bulimia Nervosa. The aim of this study was to compare the efficacy and cost-effectiveness of family therapy and cognitive behavior therapy (CBT) guided self-care in adolescents with Bulimia Nervosa or eating disorder not otherwise specified. Method: Eighty-five adolescents with Bulimia Nervosa or eating disorder not otherwise specified were recruited from eating disorder services in the United Kingdom. Participants were randomly assigned to family therapy for Bulimia Nervosa or individual CBT guided self-care supported by a health professional. The primary outcome measures were abstinence from binge-eating and vomiting, as assessed by interview at end of treatment (6 months) and again at 12 months. Secondary outcome measures included other bulimic symptoms and cost of care. Results: Of the 85 study participants, 41 were assigned to family therapy and 44 to CBT guided self-care. At 6 months, bingeing had undergone a significantly ...
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aftercare intervention through text messaging in the treatment of Bulimia Nervosa feasibility pilot
International Journal of Eating Disorders, 2006Co-Authors: Sarah Robinson, Sarah Perkins, Stephanie Bauer, Neil Hammond, Janet Treasure, Ulrike SchmidtAbstract:Objective: Even with the best available treatment, most Bulimia Nervosa (BN) sufferers are not symptom free at the end of therapy and, for those who have achieved remission, risk of relapse is high. Thus, there is a need for aftercare or relapse prevention interventions after therapy. It is not yet known what type of intervention should be delivered, and how to suit patient needs while being mindful of cost and time constraints of service providers. This pilot study was conducted to explore the feasibility, acceptability, and efficacy of a text messaging (short messaging service [SMS])-based intervention in the aftercare of BN patients who had received outpatient psychotherapy. Method: A total of 21 patients with BN participated in the 6-month SMS-based intervention as a step-down treatment AFTER outpatient therapy. Results: Levels of use of the program were relatively low and attrition high, indicating limited acceptance of the intervention. Conclusion: This study suggests that the SMS-based intervention would benefit from further adaptation to make it a more useful tool for the aftercare of patients after outpatient treatment for Bulimia Nervosa. © 2006 by Wiley Periodicals, Inc. Int J Eat Disord 2006; 39:633–638
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cognitive flexibility in anorexia Nervosa and Bulimia Nervosa
Journal of The International Neuropsychological Society, 2004Co-Authors: Kate Tchanturia, Marija Anderluh, Robin G Morris, S Rabehesketh, David A Collier, Patricia Sanchez, Janet TreasureAbstract:The aim of this study was to determine if there are differences in cognitive flexibility in anorexia Nervosa and Bulimia Nervosa. Fifty-three patients with an eating disorder (34 with anorexia Nervosa and 19 with Bulimia Nervosa) and 35 healthy controls participated in the study. A battery of neuropsychological tests for cognitive flexibility was used, including Trail Making B, the Brixton Test, Verbal Fluency, the Haptic Illusion Test, a cognitive shifting task (CatBat) and a picture set test. Using exploratory factor analysis, four factors were obtained: 1: Simple Alternation; 2: Mental Flexibility; 3: Perseveration; and 4: Perceptual Shift. Patients with anorexia Nervosa had abnormal scores on Factors 1 and 4. Patients with Bulimia Nervosa showed a different pattern, with significant impairments in Factors 2 and 4. These findings suggest that differential neuropsychological disturbance in the domain of mental flexibility0rigidity may underlie the spectrum of eating disorders. ( JINS, 2004, 10, 513‐520.)
Walter H Kaye - One of the best experts on this subject based on the ideXlab platform.
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comorbidity of anxiety disorders with anorexia and Bulimia Nervosa
American Journal of Psychiatry, 2004Co-Authors: Walter H Kaye, Cynthia M. Bulik, Nicole C Barbarich, Laura M Thornton, Kim MastersAbstract:OBJECTIVE: A large and well-characterized sample of individuals with anorexia Nervosa and Bulimia Nervosa from the Price Foundation collaborative genetics study was used to determine the frequency of anxiety disorders and to understand how anxiety disorders are related to state of eating disorder illness and age at onset. METHOD: Ninety-seven individuals with anorexia Nervosa, 282 with Bulimia Nervosa, and 293 with anorexia Nervosa and Bulimia were given the Structured Clinical Interview for DSM-IV Axis I Disorders and standardized measures of anxiety, perfectionism, and obsessionality. Their ratings on these measures were compared with those of a nonclinical group of women in the community. RESULTS: The rates of most anxiety disorders were similar in all three subtypes of eating disorders. About two-thirds of the individuals with eating disorders had one or more lifetime anxiety disorder; the most common were obsessive-compulsive disorder (OCD) (N=277 [41%]) and social phobia (N=134 [20%]). A majority of...
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genetic analysis of Bulimia Nervosa methods and sample description
International Journal of Eating Disorders, 2004Co-Authors: Walter H Kaye, Cynthia M. Bulik, Katherine A Halmi, Allan S Kaplan, Bernie Devlin, Nicole C Barbarich, Laura Thornton, Silviu Alin Bacanu, Manfred M Fichter, Michael StroberAbstract:Objective: Twin and family studies suggest that genetic variants contribute to the pathogenesis of Bulimia Nervosa (BN) and anorexia Nervosa (AN). The Price Foundation has supported an international, multisite study of families with these disorders to identify these
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altered serotonin 2a receptor activity in women who have recovered from Bulimia Nervosa
American Journal of Psychiatry, 2001Co-Authors: Walter H Kaye, Julie C Price, Carolyn C Meltzer, Guido K W Frank, Claire Mcconaha, Penelope J Crossan, Kelly L Klump, Leigh RhodesAbstract:Results: The healthy volunteers, but not the women who had recovered from Bulimia Nervosa, had an age-related decline in 5HT2A binding. Women who had recovered from Bulimia Nervosa had a reduction of medial orbital frontal cortex 5-HT2A binding. Conclusions: The lack of age-related changes in 5-HT activity is further evidence of 5-HT alterations in subjects who have recovered from Bulimia Nervosa. In addition, vulnerabilities for eating disorders, impulse dyscontrol, and mood disturbances may involve 5-HT and frontal lobe activity. (Am J Psychiatry 2001; 158:1152–1155) Bulimia Nervosa usually has an onset in adolescent women who are of normal body weight. It is characterized by restrictive eating alternating with binge eating and purging and body image distortions. Mood disturbances and extremes of impulse control such as impulsive and obsessive behaviors are common (1). Physiological and pharmacological studies support the possibility that altered central nervous system serotonin (5-HT) neurotransmitter activity could contribute to a susceptibility to develop appetitive and behavioral alterations in Bulimia Nervosa (1). Altered 5-HT activity in Bulimia Nervosa could be a consequence of pathological dietary behaviors. However, people who have recovered from Bulimia Nervosa also have 5-HT alterations as well as behavioral symptoms consistent with a dysregulation of 5-HT neuronal pathways (2, 3), raising the possibility that such alterations are trait-related and contribute to the pathogenesis of this disorder. To further understand 5-HT activity in women who have recovered from Bulimia Nervosa, we used the radioligand [ 18 F]altanserin, a specific 5-HT2A receptor antagonist, and positron emission tomography (PET) imaging. The 5HT2A receptor system has been implicated in the modulation of feeding, mood, and anxiety as well as in antidepressant efficacy (4).
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controlled family study of anorexia Nervosa and Bulimia Nervosa evidence of shared liability and transmission of partial syndromes
American Journal of Psychiatry, 2000Co-Authors: Michael Strober, Roberta Freeman, Carlyn Lampert, Jane Diamond, Walter H KayeAbstract:OBJECTIVE: Lifetime rates of full and partial anorexia Nervosa and Bulimia Nervosa were determined in first-degree relatives of diagnostically pure proband groups and relatives of matched, never-ill comparison subjects. METHOD: Rates of each eating disorder were obtained for 1,831 relatives of 504 probands on the basis of personal structured clinical interviews and family history. Best-estimate diagnoses based on all available information were rendered without knowledge of proband status and pedigree identity. Only definite and probable diagnoses were considered. RESULTS: Whereas anorexia Nervosa was rare in families of the comparison subjects, full and partial syndromes of anorexia Nervosa aggregated in female relatives of both anorexic and bulimic probands. For the full syndrome of anorexia Nervosa, the relative risks were 11.3 and 12.3 in female relatives of anorexic and bulimic probands, respectively. Bulimia Nervosa was more common than anorexia Nervosa in female relatives of comparison subjects, but...
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anorexia and Bulimia Nervosa
Annual Review of Medicine, 2000Co-Authors: Walter H Kaye, Guido K W Frank, Kelly L Klump, Michael StroberAbstract:Anorexia Nervosa (AN) and Bulimia Nervosa (BN) are disorders characterized by abnormal patterns of weight regulation and eating behavior and by disturbances in attitudes and perceptions toward weight and body shape. Etiologic research has indicated substantial genetic influence on these disorders, suggesting significant biological contributions to their development. Obsessional, perfectionistic, and anxious personality styles may be premorbid traits that contribute to this pathogenesis. Studies of neuroendocrine, neuropeptide, and neurotransmitter functioning in patients with AN and BN indicate that disturbances of these systems may contribute to the maintenance as well as the etiology of these sometimes fatal disorders. The efficacy of psychological treatments and pharmacotherapy has been more clearly established for BN than for AN.
James E Mitchell - One of the best experts on this subject based on the ideXlab platform.
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dimensions of emotion dysregulation in Bulimia Nervosa
European Eating Disorders Review, 2014Co-Authors: Jason M Lavender, James E Mitchell, Stephen A Wonderlich, Scott G Engel, Tracey L Smith, Marjorie H Klein, Andrea B GoldschmidtAbstract:The goal of this study was to examine associations between dimensions of emotion dysregulation and eating disorder (ED) symptoms in Bulimia Nervosa (BN). This investigation used baseline data from a BN treatment study that included 80 adults (90% women) with full or subthreshold BN. Participants completed the Difficulties in Emotion Regulation Scale (DERS) and the Eating Disorders Examination (EDE) interview. The EDE global score was significantly correlated with the DERS total score, as well as several DERS subscales: Nonacceptance, Impulse, and Strategies. Further, the DERS Goals subscale was found to be uniquely associated with frequency of purging and driven exercise, although none of the subscales were associated with frequency of objective binge eating. Findings indicate that emotion dysregulation is associated with ED symptoms in BN, suggesting the utility of interventions that address emotion regulation skills deficits in the treatment of the disorder.
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stepped care and cognitive behavioural therapy for Bulimia Nervosa randomised trial
British Journal of Psychiatry, 2011Co-Authors: James E Mitchell, Christopher G Fairburn, Scott J Crow, Katherine A Halmi, Stewart Agras, Susan W Bryson, Helena C KraemerAbstract:Background This study compared the best available treatment for Bulimia Nervosa, cognitive-behavioural therapy (CBT) augmented by fluoxetine if indicated, with a stepped-care treatment approach in order to enhance treatment effectiveness. Aims To establish the relative effectiveness of these two approaches. Method This was a randomised trial conducted at four clinical centres ([Clinicaltrials.gov][1] registration number: [NCT00733525][2]). A total of 293 participants with Bulimia Nervosa were randomised to one of two treatment conditions: manual-based CBT delivered in an individual therapy format involving 20 sessions over 18 weeks and participants who were predicted to be non-responders after 6 sessions of CBT had fluoxetine added to treatment; or a stepped-care approach that began with supervised self-help, with the addition of fluoxetine in participants who were predicted to be non-responders after six sessions, followed by CBT for those who failed to achieve abstinence with self-help and medication management. Results Both in the intent-to-treat and completer samples, there were no differences between the two treatment conditions in inducing recovery (no binge eating or purging behaviours for 28 days) or remission (no longer meeting DSM-IV criteria). At the end of 1-year follow-up, the stepped-care condition was significantly superior to CBT. Conclusions Therapist-assisted self-help was an effective first-level treatment in the stepped-care sequence, and the full sequence was more effective than CBT suggesting that treatment is enhanced with a more individualised approach. [1]: http://Clinicaltrials.gov [2]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT00733525&atom=%2Fbjprcpsych%2Fearly%2F2011%2F03%2F17%2Fbjp.bp.110.082172.atom
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increased mortality in Bulimia Nervosa and other eating disorders
American Journal of Psychiatry, 2009Co-Authors: Scott J Crow, Carol B Peterson, Sonja A Swanson, Nancy C Raymond, Sheila M Specker, Elke D Eckert, James E MitchellAbstract:Objective: Anorexia Nervosa has been consistently associated with increased mortality, but whether this is true for other types of eating disorders is unclear. The goal of this study was to determine whether anorexia Nervosa, Bulimia Nervosa, and eating disorder not otherwise specified are associated with increased all-cause mortality or suicide mortality. Method: Using computerized record linkage to the National Death Index, the authors conducted a longitudinal assessment of mortality over 8 to 25 years in 1,885 individuals with anorexia Nervosa (N=177), Bulimia Nervosa (N=906), or eating disorder not otherwise specified (N=802) who presented for treatment at a specialized eating disorders clinic in an academic medical center. Results: Crude mortality rates were 4.0% for anorexia Nervosa, 3.9% for Bulimia Nervosa, and 5.2% for eating disorder not otherwise specified. All-cause standardized mortality ratios were significantly elevated for Bulimia Nervosa and eating disorder not otherwise specified; suicid...
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overvaluation of shape and weight in binge eating disorder Bulimia Nervosa and sub threshold Bulimia Nervosa
Behaviour Research and Therapy, 2009Co-Authors: Carlos M Grilo, Ross D. Crosby, Scott J Crow, Carol B Peterson, Stephen A Wonderlich, Scott G Engel, Robin M Masheb, Marney A White, James E MitchellAbstract:Increasing empirical evidence supports the validity of binge eating disorder (BED), a research diagnosis in the appendix of DSM-IV, and its inclusion as a distinct and formal diagnosis in the DSM-V. A pressing question regarding the specific criteria for BED diagnosis is whether, like Bulimia Nervosa (BN), it should be characterized by overvaluation of shape and weight. This study compared features of eating disorders in 436 treatment-seeking women comprising four groups: 195 BED participants who overvalue their shape/weight, 129 BED participants with subclinical levels of overvaluation, 61 BN participants, and 51 participants with sub-threshold BN. The BED clinical overvaluation group had significantly higher levels of specific eating disorder psychopathology than the three other groups which did not differ significantly from each other. Findings suggest that overvaluation of shape and weight should not be considered as a required criterion for BED because this would exclude a substantial proportion of BED patients with clinically significant problems. Rather, overvaluation of shape and weight warrants consideration either as a diagnostic specifier or as a dimensional severity rating as it provides important information about severity within BED.
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emotional states preceding and following acts of non suicidal self injury in Bulimia Nervosa patients
Behaviour Research and Therapy, 2009Co-Authors: Jennifer J Muehlenkamp, Ross D. Crosby, Stephen A Wonderlich, Scott G Engel, Andrea Wadeson, Heather Simonich, James E MitchellAbstract:Bulimia Nervosa and non-suicidal self-injury (NSSI) co-occur at high rates, and both have been conceptualized as maladaptive emotion regulation strategies. Treatments focusing on emotion regulation have been designed for both problem behaviors, yet, there exists very little research examining the temporal emotional states surrounding acts of NSSI. Using ecological momentary assessment (EMA) methodology, the current study examined the temporal association between positive and negative emotional states prior to and consequent to acts of NSSI within a subset of Bulimia Nervosa patients. Results indicate significant increases in negative affect, and decreases in positive affect, prior to an NSSI act. Post-NSSI, positive affect significantly increased while negative affect remained unchanged. The findings offer partial support for an emotion regulation paradigm to understanding NSSI within bulimic populations and implications for treatment are discussed.
Marianne E Oconnor - One of the best experts on this subject based on the ideXlab platform.
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the natural course of Bulimia Nervosa and binge eating disorder in young women
Archives of General Psychiatry, 2000Co-Authors: Christopher G Fairburn, Zafra Cooper, Helen Doll, Patricia A Norman, Marianne E OconnorAbstract:Background: Little is known about the relative course and outcome of Bulimia Nervosa and binge eating disorder. Methods: Two community-based cohorts were studied prospectively over a 5-year year period. One comprised 102 participants with Bulimia Nervosa and the other 48 participants with binge eating disorder (21% [9/42] of whom had comorbid obesity). All participants were female and aged between 16 and 35 years at recruitment. The assessments were at 15-month intervals and addressed eating disorder features, general psychiatric symptoms, and social functioning. Results: Both cohorts showed marked initial improvement followed by gradual improvement thereafter. Between half and two thirds of the Bulimia Nervosa cohort had some form of eating disorder of clinical severity at each assessment point, although only a minority continued to meet diagnostic criteria for Bulimia Nervosa. Each year about a third remitted and a third relapsed. The outcome of the binge eating disorder cohort was better, with the proportion with any form of clinical eating disorder declining to 18% (7 of 40) by the 5-year follow-up. The relapse rate was low among this cohort. There was little movement of participants across the 2 diagnostic categories and few sought treatment. Both groups gained weight, with 39% of the binge eating disorder cohort (14 of 36) meeting criteria for obesity at 5-year follow-up. Conclusions: These findings suggest that, among young women in the community, Bulimia Nervosa and binge eating disorder have a different course and outcome. Whereas the prognosis of those with Bulimia Nervosa was relatively poor, the great majority of those with binge eating disorder recovered. Arch Gen Psychiatry. 2000;57:659-665
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a prospective study of outcome in Bulimia Nervosa and the long term effects of three psychological treatments
Archives of General Psychiatry, 1995Co-Authors: Christopher G Fairburn, Helen Doll, Marianne E Oconnor, Patricia A Norman, Sarah Welch, Robert PevelerAbstract:Background: Little is known about the longer-term outcome of Bulimia Nervosa and the distal effects of treatment. Methods: Prospective follow-up of subjects from two randomized controlled trials, involving a comparison of cognitive behavior therapy, behavior therapy, and focal interpersonal therapy. Results: Ninety percent (89/99) underwent reassessment by interview (mean [±SD] length of follow-up, 5.8±2.0 years). Almost half (46%) had a DSM-IV eating disorder; 19%, Bulimia Nervosa; 3%, anorexia Nervosa; and 24%, eating disorder not otherwise specified. There was a low rate of other psychiatric disorders. Premorbid and paternal obesity predicted a poor outcome. While the three treatments did not differ with respect to the pro-portion of subjects with anorexia Nervosa or Bulimia Nervosa at follow-up, they did differ once all forms of DSM-IV eating disorder were considered together. Those who had received cognitive behavior therapy or focal interpersonal therapy were doing markedly better than those who had received behavior therapy. Conclusions: The longer-term outcome of Bulimia Nervosa depends on the nature of the treatment received. Patients who receive a treatment such as behavior therapy, which only has a short-lived effect, tend to do badly, whereas those who receive treatments such as cognitive behavior therapy or focal interpersonal therapy have a better prognosis.
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psychotherapy and Bulimia Nervosa longer term effects of interpersonal psychotherapy behavior therapy and cognitive behavior therapy
Archives of General Psychiatry, 1993Co-Authors: Christopher G Fairburn, Rosemary Jones, Robert Peveler, R A Hope, Marianne E OconnorAbstract: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 withdrawl 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.
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three psychological treatments for Bulimia Nervosa a comparative trial
Archives of General Psychiatry, 1991Co-Authors: Christopher G Fairburn, Marianne E Oconnor, Rosemary Jones, Robert Peveler, Sally J Carr, Ruth A Solomon, Jenny Burton, R A HopeAbstract:• The specificity and magnitude of the effects of cognitive behavior therapy in the treatment of Bulimia Nervosa were evaluated. Seventy-five patients who met strict diagnostic criteria were treated with either cognitive behavior therapy, a simplified behavioral version of this treatment, or interpersonal psychotherapy. Assessment was by interview and self-report questionnaire, and many aspects of functioning were evaluated. All three treatments resulted in an improvement in the measures of the psychopathology. Cognitive behavior therapy was more effective than interpersonal psychotherapy in modifying the disturbed attitudes to shape and weight, extreme attempts to diet, and self-induced vomiting. Cognitive behavior therapy was more effective than behavior therapy in modifying the disturbed attitudes to shape and weight and extreme dieting, but it was equivalent in other respects. The findings suggest that cognitive behavior therapy, when applied to patients with Bulimia Nervosa, operates through mechanisms specific to this treatment and is more effective than both interpersonal psychotherapy and a simplified behavioral version of cognitive behavior therapy.
