Pretreatment Cues Help Predict Short-term Outcome in Bulimic Patients

Although many studies have been done on outcome in bulimia nervosa, little has been done to identify prognostic factors among these patients. According to Cynthia M. Bulik, PhD, and colleagues, certain characteristics can help pinpoint bulimic patients who are likely to have poorer response to treatment.

Dr. Bulik and her co-workers randomly assigned 106 bulimic women to 1 of 3 groups: (1) those who were exposed to pre-binge-eating cues (B-ERP); (2) those who were exposed (with response prevention) to pre-purge cues (P-ERP); or (3) a control group who received relaxation therapy.

Before the women began treatment, a cue reactivity assessment was performed that examined heart rate and blood pressure, urges to binge and to purge, and affective responses to high-risk foods most likely to trigger a binge. To test high-risk foods, a platter holding the highest risk foods was placed before the subject, who was invited to look at, smell, and finally to eat as much of the foods as she could. The subject then reported her urge to binge, or urge to purge, and her level of distress at 2-minute intervals. Once the subject decided to stop eating, the food platter was removed.

What researchers learned

One year after the end of treatment, 38% of the 101 women available for follow-up reported no bingeing or purging, and 45% binged and/or purged, but not more than twice a week on average. Sixteen percent had continued to binge-eat and purge twice a week or more often.

Certain characteristics pointed to poor outcome at 1 year: lower global functioning, higher-self-reported bulimia scores on the Eating Disorders Inventory, and a current major depression. Patients who were doing poorly in several areas also did less well with cognitive behavioral therapy (CBT).

The odds of a poor outcome were three times greater in patients who had major depression when they first sought treatment for their eating disorder. The odds of a poor outcome were also increased if the woman continued to restrict eating at the end of treatment or had a strong urge to binge when confronted with risky foods.

In contrast, women with uncomplicated cases of bulimia nervosa, who were functioning well in both their social lives and at work, seemed to be good candidates for short-term, focused treatment. Women who had the trait of self-directedness were good candidates for good outcome from CBT.

Goals before treatment ends

The authors believe that achieving abstinence from binge-eating, eliminating restrictive eating patterns (dieting), and decreasing reactivity to cues (especially the urge to binge) are important treatment goals to achieve before ending treatment. If treatment is stopped before such behaviors are controlled, patients may have poor long-term results (Comprehensive Psychiatry 39:206, 1998).