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How well does treatment for bulimia nervosa work?

ECRI Institute, the organization that researched and produced this guide, identified and analyzed all the available clinical trials published from 2005 through July 2010 on the treatments typically used for bulimia nervosa to determine how treatments compare to each other and which seem to work best.

Analysts pooled together data from studies that compared one active treatment to another active treatment. The studies met prespecified inclusion criteria (e.g., randomized controlled trials that included 20 or more patients) that are discussed in detail in the full technical evidence report. Analysts compared the effectiveness cognitive behavioral therapy (CBT) to drug therapy and CBT to other types of psychotherapies, among other comparisions.

What are the main results of the analysis?
  • CBT was more effective than antidepressant medications in reducing the average number of binge eating episodes for some individuals.
  • Patients who receive CBT are more likely to go into remission from vomiting than patients treated with supportive therapies (34% versus 12%, respectively). (Supportive therapies focus on management and resolution of personal difficulties and life decisions using the patient's strengths.)
  • CBT is more effective than supportive therapies in improving eating disorder symptoms for some individuals.
  • CBT is more effective than behavioral therapy in reducing the average number of vomiting episodes for some individuals.
  • Therapist-led CBT is more effective than self help CBT in reducing symptoms of depression.
  • Because of the differences in how treatments were provided, we could not determine the effectiveness of family-based therapy compared to other forms of psychotherapy for patients with bulimia nervosa.
  • The data did not provide clear evidence that enabled us to determine whether CBT plus exposure response prevention therapy therapy aimed at preventing purging until the patient's anxiety associated with eating subsides is better than CBT alone for the outcomes of remission, depression, and frequency of purging.
  • The data did not provide clear evidence for us to determine whether CBT plus an antidepressant is better than CBT alone or an antidepressant alone for reducing the frequency of binge eating or purging.
  • Too few published data were available to determine whether inpatient treatment is more or less effective than outpatient treatment for bulimia nervosa.

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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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