Bulimia nervosa (BN) is a disabling eating disorder and affects as many as 2% of young women. It is a major source of psychiatric and medical morbidity that often impairs several areas of functioning. BN is occurring with increasing frequency among adolescents and preadolescents. Applying stringent diagnostic criteria for BN, studies have found 2-5% of adolescent girls surveyed qualify for diagnosis of BN. Research specific to treatment of child and adolescent eating disorders remains limited. No psychological treatment has been systematically evaluated in the treatment of adolescents with BN. The rationale for the proposed study derives from the candidate's participation in the conduct of treatment studies for adolescents with anorexia nervosa at the Maudsley Hospital in London. These data indicate that a specific form of family therapy is effective in the treatment of adolescents with anorexia nervosa. Involving the parents and siblings in treatment has beneficial effects on reversing the course of the eating disorder as well as improving family interaction. A preliminary report from the Maudsley group has also shown that this family therapy may be helpful in the treatment of adolescents with BN. Because most young adolescents still live with their families of origin, and are embedded in their families. This raises the important clinical possibility that adolescent BN patients can also be successfully treated with family therapy. We hypothesize that family therapy is an effective and essential way to reduce binging and purging in adolescents with BN, and will lead to long-term amelioration of bulimic symptoms. In the proposed study we aim to adapt and pilot a recently developed family therapy manual for adolescent anorexia nervosa for use in the treatment of adolescent BN patents, and to compare the efficacy of this conceptually and procedurally distinct family therapy treatment with a manualized individual control psychotherapy. To achieve these aims, we propose a five-year controlled treatment study to be carried out at The University of Chicago. Ninety newly referred adolescents meeting DSM-IV diagnostic criteria for BN will be randomly allocated to one of two groups: 1) family therapy or 2) individual supportive control treatment. All patients will receive the same medical evaluation and monitoring throughout the study period. Assessment of psychiatric and medical outcome measures will be carried out at the onset of treatment, during treatment, at the end of treatment, and again at six-month follow-up. The primary clinical outcome variables assessed will be binge and purge frequency (Eating Disorder Examination), while secondary outcome variables will include the Schedule for Affective Disorders and Schizophrenia, Rosenberg Self-esteem Scale, and Expressed Emotion. The candidate is a clinical psychologist who seeks to acquire skills in sophisticated statistical techniques for longitudinal data analysis, more in-depth knowledge of child and adolescent development and mentoring to conduct an independent controlled treatment trial in adolescent BN. This award will allow the candidate to train in appropriate research methodology and statistical procedures, and provide instruction, mentorship and experience in conducting a randomized trial of psychosocial treatments. Dr. Le Grange will engage in course work, workshops, controlled treatment trial research, and have ongoing mentorship from experts in the field. Through this award, the candidate will be able to build upon his prior experience as a participant in the conduct of controlled studies, put himself in a competitive position to apply for funding in the future, and establish himself as an independent treatment outcomes researcher.
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