Family-based treatment more effective than supportive psychotherapy in treating bulimia

September 03, 2007

Bulimia patients age 12 to 19 years who received family-based treatment were less likely to continue to binge and purge than those who received supportive psychotherapy, which explores the underlying issues of the disorder, according to a report in the September issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

"Bulimia nervosa (BN) is a disabling eating disorder with a prevalence of 1 percent to 2 percent among adolescents, while another 2 percent to 3 percent of adolescents present with bulimic symptoms that are clinically significant but do not meet full threshold criteria," according to background information in the article. The disorder is characterized by episodes of excessive eating, or bingeing, combined with inappropriate weight loss methods, such as purging (vomiting), using laxatives or exercising obsessively.

Daniel le Grange, Ph.D., of the University of Chicago, and colleagues analyzed 80 patients (age 12 to 19, average age 16.1), 37 with bulimia and 43 with bulimic symptoms. Between 2001 and 2006, 41 were randomly assigned to family-based treatment and 39 to supportive psychotherapy. Family-based treatment involves parents, does not address underlying causes of the condition, seeks to separate bulimics from their symptoms and empowers them to change their behaviors. Supportive psychotherapy does not contain active advice on changing eating patterns, but instead helps patients resolve underlying emotional issues at the root of the disorder. The patients each attended 20 outpatient visits over six months and were assessed before treatment, midway through, immediately following and at six months after treatment.

More patients receiving family-based treatment (16, or 39 percent) than supportive psychotherapy (7, or 18 percent) achieved remission--defined as abstaining from binge eating and compensatory behavior, such as purging--immediately following treatment. "Somewhat fewer patients were abstinent at the six-month follow-up; however, the difference was statistically in favor of family-based treatment vs. supportive psychotherapy (12 patients [29 percent] vs. 4 patients [10 percent])," the authors write.

"Results suggest that family-based treatment for bulimia nervosa is promising in the amelioration of symptomatic behavior for this disorder," the authors conclude. "However, we do not know whether it is family involvement or the focus on eating behavior that is key to good treatment outcome. Moreover, abstinence rates between 30 percent and 40 percent leave considerable room for improvement."
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(Arch Gen Psychiatry. 2007;64(9):1049-1056. Available pre-embargo to the media at www.jamamedia.org.)

Editor's Note: This study was supported by a grant from the National Institute of Mental Health (Dr. le Grange). Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

For more information, contact JAMA/Archives Media Relations at 312/464-JAMA (5262) or e-mail mediarelations@jama-archives.org.

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