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About this Resource Guide
"I found a support group to be too much of a trigger," explained a patient who said that groups can sometimes digress into competitions to lose weight or unhealthy techniques to keep weight off.

This resource guide is available in several formats, most of which are free: on this Web site; in print (for a nominal shipping/handling cost) through the National Eating Disorders Association (NEDA) online store www.nationaleatingdisorders.org as of April 1, 2006; and at ECRI Institute's Web site www.ecri.org under "patient information." This resource guide is part of ECRI Institute's National Patient Library™ of evidence-based healthcare guides for consumers.

An evidence-based approach to patient information

ECRI Institute's approach to producing this guide is unique in the field of patient information because of its evidence-based approach to addressing questions posed by families' and patients' concerns about bulimia nervosa. Evidence-based means that the information we present is based on careful analysis of the available published clinical research about bulimia nervosa and its treatment. Evidence-based medicine involves using the results of published clinical research to guide routine decisions about how best to diagnose and treat diseases and conditions.

The late Mrs. Hilda Davis, whose foundation funded much of this work, desired to benefit the public good by providing evidence-based information about diagnosis and treatment of bulimia nervosa to help families affected by the disorder. To identify questions that families and patients had about bulimia nervosa, ECRI Institute established an external advisory committee of patients and family members affected by the disorder. This committee also included clinicians and specialists who treat eating disorders, scientists who conduct research on eating disorders, health insurance representatives, and others who affect patient care for the disorder. The committee posed more than 150 far-ranging questions about bulimia nervosa, its prevalence, incidence, diagnosis, treatment, access to care, and insurance issues. ECRI Institute has made every effort to use the best available published evidence to address these questions in the guide.

In particular, the guide's discussion of treatment effectiveness is based on results of ECRI Institute's comprehensive analysis (also called a systematic review and evidence report) of all the available published clinical studies on treatments for bulimia nervosa. ECRI Institute pooled data from scores of clinical studies to discern how well each type of treatment works and for whom it works best. This effort reflects the most comprehensive analysis done to date on bulimia nervosa. The results point out areas where more research is needed to address questions about various treatments that can not yet be answered definitively, or in some cases, at all. Part of the rigor of ECRI Institute's analysis included critical review of the preliminary draft by clinical members of the committee and other external experts on eating disorders. This review led to revisions to ensure the rigor and thoroughness of the report. Likewise, all content on the Web site underwent review by the committee and additional patients, families, and others familiar with the disorder to help ensure that we appropriately addressed questions and offered useful resources.

ECRI Institute gratefully acknowledges the contributions of all of these people. ECRI Institute also gratefully acknowledges the support and guidance the National Eating Disorders Association offered through its past and current presidents and administrative staff.

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Bulimia nervosa is an eating disorder in which a person engages in binge eating (eating a lot of food in a short time) followed by some type of behavior to prevent weight gain from the food that was eaten. This behavior can take two forms: self-induced vomiting, misuse of enemas, laxatives, diet pills (called purging) and excessive exercise, fasting, or diabetic omission of insulin (called non-purging). Some people with bulimia nervosa may also starve themselves for periods of time before binge eating again. Bulimia nervosa has important mental, emotional, and physical aspects that require consideration during treatment.

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