A review of the behavioral treatment of bulimia nervosa suggests that it consists of two components: nutritional counseling and cognitive behavioral treatment. Both components show great promise but they have not been adequately studied, spearately or in combination. We propose to investigate whether each component is effective on its own, and if a combination of the two is more effective than either alone. We will study three individual treatments: nutritional counseling, cognitive behavioral treatment, and combined cognitive behavioral and nutritional treatment, against a minimal treatment condition of attendance at a support group. In addition to patients' self- reports, the change in binge frequency pre- and post-treatment will measured directly in an Eating Disorders Research Laboratory. In pursuing this primary purpose, we will also examine: (1) the specific effects of each treatment on eating attitudes, depressive symptomatology and social adjustment; (2) the predictors of response to each treatment; (3) the 12 month outcome using defined criteria and the prognostic indicators. Patients will be randomly assigned to one of four treatment conditions (3 active, one minimal) after blocking on major depression. Treatment will consist of 16 sessions, conducted over a 14 week period (4 sessions in the first 2 weeks, 12 weekly ones). Active treatments will be conducted by experienced clinicians according to written manuals. All sessions will be audiotaped for monitoring compliance and fidelity. An Independent Assessor """"""""blind"""""""" to the patient's treatment condition will conduct all the assessments. All patients will be followed-up for 1 year after treatment. The treatment of bulimia nervosa is important because the disorder carries considerable morbidity and seems to be common. Many patients are discouraged by the lack of effectiveness of non-specific treatments. Current outcome data suggest that the illness does not remit with time and may associated with increased mortality. Hence, it is imperative that we should continue to search for an effective treatment for bulimia.
| Hsu, L K; Rand, W; Sullivan, S et al. (2001) Cognitive therapy, nutritional therapy and their combination in the treatment of bulimia nervosa. Psychol Med 31:871-9 |
| Weltzin, T E; Hsu, L K; Pollice, C et al. (1991) Feeding patterns in bulimia nervosa. Biol Psychiatry 30:1093-110 |
