Bulimia Nervosa is a major source of psychiatric morbidity among young women, which often runs a chronic course. It is widely assumed that this disorder cannot be treated effectively in a primary care setting. This assumption has never been tested empirically, and is probably incorrect. In the last 15 years, effective treatment interventions for Bulimia Nervosa have been developed and validated in specialized treatment centers. The broad aim of this proposal is to examine whether these treatments, suitably adapted, can be usefully transferred to general health care settings. Specifically, the proposed study will determine the relative and combined effectiveness of the two leading treatments for Bulimia Nervose in a primary care setting. The two major interventions are treatment with an antidepressant medication, fluoxetine, and with a form of cognitive behavioral therapy, guided self-help, designed for use in primary care. Over four years, 200 women with Bulimia Nervosa will be treated in a suburban, primary care setting. Patients will be randomly assigned to receive (1) either fluoxetine or placebo and (2) either guided self-help combined with medical management or medical management alone. Changes in eating behavior and in psychological state will be assessed at the end of active treatment (4 months) and 4 and 8 months after the end of treatment.
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