Treatment of laxative abuse in a female with bulimia nervosa using an operant extinction paradigm.
Chronic laxative abuse was treated using an operant extinction paradigm in a 29-year-old woman with bulimia nervosa. Access to self-administration of laxative and placebo were alternated in an ABAB design. Outcome was measured by self-reported craving for laxatives and rates of drug self-administration. During baseline, the subject exhibited high rates of both craving and self-administration. During placebo phases, cravings and drug self-administration declined. Both measures increased when active drug was reinstated. The final return to placebo led to a decrease in craving and extinction of drug self-administration to zero doses per day. This paper introduces the concept of laxatives as reinforcers and provides a new approach to the treatment of laxative abuse in women with bulimia nervosa.
Bulik
C M
CM
University of Pittsburgh School of Medicine, Department of Psychiatry, Western Psychiatric Institute & Clinic, PA 15213.
Epstein
L H
LH
Kaye
W
W
D000328:Adult; D001521:Behavior Therapy / Q000379:methods*; D002032:Bulimia / Q000523:psychology / Q000534:rehabilitation*; D002400:Cathartics; D015928:Cognitive Behavioral Therapy / Q000379:methods; D003131:Combined Modality Therapy; D003216:Conditioning, Operant; D004311:Double-Blind Method; D005108:Extinction, Psychological; D005260:Female; D005473:Fluoxetine / Q000008:administration & dosage; D006801:Humans; D019966:Substance-Related Disorders / Q000523:psychology / Q000534:rehabilitation*
D002400:Cathartics; D005473:Fluoxetine