Abstract
The extent to which cognitive-behavioral therapy (CBT) is helpful in treating individuals with bulimic symptoms who do not meet full criteria for bulimia nervosa is unclear. The purpose of this investigation was to examine the potential efficacy of CBT for eating disorder individuals with bulimic symptoms who do not meet full criteria for bulimia nervosa. Twelve participants with subthreshold bulimia nervosa were treated in a case series with 20 sessions of CBT. Ten of the 12 participants (83.3%) completed treatment. Intent-to-treat abstinent percentages were 75.0% for objectively large episodes of binge eating (OBEs), 33.3% for subjectively large episodes of binge eating (SBEs), and 50% for purging at end of treatment. At one year follow-up, 66.7% were abstinent for OBEs, 41.7% for SBEs, and 50.0% for purging. The majority also reported improvements in associated symptoms. This case series provides support for the use of CBT with individuals with subthreshold bulimia nervosa.
References
Fairburn CG, Marcus MD, Wilson GT. Cognitivebehavioral therapy for binge eating and bulimia nervosa: A comprehensive treatment manual. In: Fairburn CG, Wilson GT (Eds) Binge eating: nature, assessment, and treatment. New York, Guilford Press, 1993, pp 361–404.
Anderson DA, Maloney KC. The efficacy of cognitivebehavioral therapy on the core symptoms of bulimia nervosa. Clin Psychol Rev 2001; 25: 971–88.
Shapiro JR, Berkman ND, Brownley KA, et al. Bulimia nervosa treatment: A systematic review of the randomized controlled trials. Int J Eating Disord 2007; 40: 321–36.
Thompson-Brenner H, Glass S, Westen D. A multidimensional meta-analysis of psychotherapy for bulimia nervosa. Clin Psychol Sci Pract 2003; 10: 269–87.
Wilson GT. Psychological treatment of eating disorders. Annu Rev Clin Psychol 2005; 1: 439–65.
National Institute for Clinical Excellence. Eating disorders: core interventions in the treatment and management of anorexia nervosa, bulimia nervosa, and related eating disorders. NICE Clinical Guidelines. London, NICE, 2004 (http://www.nice.org.uk).
Fairburn CG, Bohn K. Eating disorder NOS (EDNOS): An example of the troublesome “not otherwise specified” (NOS) category in DSM-IV. Behav Res Ther 2005; 43: 691–701.
Machado PP, Machado BC, Goncalves S, et al. The prevalence of eating disorders not otherwise specified. Int J Eat Disord 2007; 40: 212–7.
Crow SJ, Agras WS, Halmi K, et al. Full syndromal versus subthreshold anorexia nervosa, bulimia nervosa, and binge eating disorder: A multicenter study. Int J Eat Disord 2002; 32: 309–18.
Brownley KA, Berkman ND, Sedway JA, et al. Binge eating disorder treatment: a systematic review of randomized controlled trials. Int J Eat Disord 2007; 40: 337–48.
Wonderlich SA, de Zwaan M, Mitchell JE, et al. Psychological and dietary treatments of binge eating disorder: Conceptual implications. Int J Eat Disord 2003; 34: S58–73.
Fairburn CG, Cooper Z, Doll H, et al. Transdiagnostic cognitive-behavioral therapy for patients with eating disorders: A two-site trial with 60-week follow-up. Am J Psychiatry 2009; 166: 311–9.
Fairburn CG, Cooper Z. The eating disorders examination (12th ed). In: Fairburn CG, Wilson GT (Eds) Binge eating: nature, assessment, and treatment. New York, Guilford Press, 1993, pp 317–31.
First M, Spitzer RL, Gibbon M, et al. Structured Clinical Interview for DSM-IV Axis I Disorders-Patient edition, v. 2. New York, Biometrics Research Department, 1995.
Fairburn CG. Cognitive behavior therapy and eating disorders. New York, Guilford Press, 2008.
Rizvi SL, Peterson CB, Crow SJ, et al. Test-retest reliability of the Eating Disorder Examination. Int J Eat Disord 2000; 28: 311–6.
Beck AT, Ward CM, Mendelson M, et al. An inventory for measuring depression. Arch Gen Psychiatry 1961; 4: 561–71.
Beck AT, Steer RA, Garbin MG. Psychometric properties of the BDI: 25 years of evaluation. Clin Psychol Rev 1988; 8: 77–100.
Agras WS, Walsh BT, Fairburn CG, et al. A multicenter comparison of cognitive-behavioral therapy and interpersonal therapy for bulimia nervosa. Arch Gen Psychiatry 2000; 57: 459–66.
Mitchell JE, Crosby RD, Wonderlich SA, et al. A randomized trial comparing the efficacy of cognitivebehavioral therapy for bulimia nervosa delivered via telemedicine versus face-to-face. Behav Res Ther 2008; 46: 581–92.
Crow SJ, Peterson CB, Swanson SA, et al. Increased mortality in bulimia nervosa and other eating disorders. Am J Psychiatry 2009; 166: 1342–6.
le Grange D, Binford RB, Peterson CB, et al. DSM-IV threshold versus subthreshold bulimia nervosa. Int J Eat Disord 2006; 39: 462–7.
Peebles R, Hardy KK, Wilson JL, et al. Are diagnostic criteria for eating disorders markers of medical severity? Pediatrics 2010; 125: 1193–201.
Steinhausen H, Weber S. The outcome of bulimia nervosa: Findings from one-quarter century of research. Am J Psychiatry 2009; 166: 1331–41.
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Peterson, C.B., Miller, K.B., Willer, M.G. et al. Cognitive-behavioral therapy for subthreshold bulimia nervosa: A case series. Eat Weight Disord 16, e204–e208 (2011). https://doi.org/10.1007/BF03325133
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DOI: https://doi.org/10.1007/BF03325133