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How Should Bulimia Nervosa in Adolescents Be Treated?

After a year, family therapy seemed as effective as the less-expensive CBT.

In randomized, controlled trials, family therapy was superior to individual therapy for adolescents with anorexia nervosa, but no controlled treatment studies have been reported for teens with bulimia nervosa. In this British study, 85 adolescents with bulimia nervosa or eating disorders not otherwise specified (a more broadly defined diagnosis) were randomized to family therapy (FT; 13 sessions plus 2 individual sessions over 6 months) or to therapist-supported, self-guided, manual-based, cognitive-behavioral therapy (10 weekly sessions, 3 monthly follow-up sessions, and 2 sessions with a "close other").

Mean age was 17.6 years, and mean illness duration was 2.5 years; 34% of patients were taking antidepressant medications. Contrary to hypothesis, FT did not show superiority to CBT. In an intent-to-treat analysis, significantly more CBT recipients than FT recipients had stopped bingeing at 6 months. At 12 months, between-group differences were negligible; mean weekly episodes of purging dropped from 9.7 to approximately 2.5 in the entire group, and only 20.8% took antidepressants. The mean cost for CBT was 60% of that for FT.

Comment: Fifteen eligible adolescents declined to participate because they didn’t want their families involved, and 25 of 85 enrollees dropped out. The study population was too small to ascertain whether those taking medications differed from the others in comorbid diagnoses, severity, treatment response, or other measures. The study also lacked a waiting-list or placebo control and a group that received combined FT/CBT treatment. Overall, these findings suggest that adolescents with bulimia nervosa can benefit from CBT and that FT is also useful. Future studies may provide better guidance on how best to select these approaches or combine them with effective medications.

— Joel Yager, MD

Published in Journal Watch Psychiatry May 7, 2007

Citation(s):

Schmidt U et al. A randomized controlled trial of family therapy and cognitive behavior therapy guided self-care for adolescents with bulimia nervosa and related disorders. Am J Psychiatry 2007 Apr; 164:591-8.

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