Reprinted from Eating Disorders Review
May/June 2003 Volume 13, Number 3
©2002 Gürze Books
Bulimia nervosa is a complex condition with many different facets Given the broad range of its psychopathology, it is surprising that so few aspects of the disorder have been assessed in studies of its treatment
—Fairburn et al, 1986
Cognitive-behavioral therapy (CBT) is widely recognized as the treatment of choice for bulimia nervosa (BN). But what about long-term effects? A 10-year follow-up study of 101 women has shown that patients treated with CBT or an antidepressant or both have better psychosocial adjustment than women treated with placebo (Int J Eat Disord 2002;31:151).
In 1990, Dr. James E. Mitchell and colleagues reported a study in which women who met DSM-III criteria for bulimia nervosa and who reported binge eating coupled with purging episodes at least 3 times a week for least 6 months prior to the study. The women who qualified for the study were randomized to one of the following treatment groups: (1) CBT plus the antidepressant agent imipramine; (2) CBT plus placebo; (3) imipramine alone; or (4) placebo alone.
Follow-up: 92% participate
Approximately 10 years later, the researchers located 115 of the women who had completed 10 weeks of treatment in their individual categories; 101 participated in the follow-up. The women completed a number of structured clinically validated self-report questionnaires at baseline and follow-up.
Combination therapy worked best
The researchers found that the combination of CBT and antidepressant that improved short-term outcome in patients with BN also had a positive long-term effect, particularly upon social adjustment. According to the authors, this is the first study to indicate that treatment with antidepressants impacts long-term outcome. Significant differences were reported between women in the placebo group and women in the three active treatment groups, but no significant differences were found among the three active treatment groups.
Among the women in the active treatment group, follow-up Social Adjustment Scale-Self-Report (SAS-SR) scores fell below reported norms for women with depression, alcoholism, and schizophrenia, below scores reported by women with BN, and below scores reported by women 3 years after treatment for BN. (On the SAS-SR questionnaire, the lower the rating, the better the psychosocial adjustment.) In all three treatment groups, the 10-year outcomes were sustained; those in the combination treatment group had significantly better psychosocial adjustment. In contrast, women in the placebo group reported SAS-SR scores similar to those among actively bulimic women.