A prospective study of outcome in bulimia nervosa and the long-term effects of three psychological treatments.
BACKGROUND
Little is known about the longer-term outcome of bulimia nervosa and the distal effects of treatment.


METHODS
Prospective follow-up of subjects from two randomized controlled trials, involving a comparison of cognitive behavior therapy, behavior therapy, and focal interpersonal therapy.


RESULTS
Ninety percent (89/99) underwent reassessment by interview (mean [+/- SD] length of follow-up, 5.8 +/- 2.0 years). Almost half (46%) had a DSM-IV eating disorder; 19%, bulimia nervosa; 3%, anorexia nervosa; and 24%, eating disorder not otherwise specified. There was a low rate of other psychiatric disorders. Premorbid and paternal obesity predicted a poor outcome. While the three treatments did not differ with respect to the proportion of subjects with anorexia nervosa or bulimia nervosa at follow-up, they did differ once all forms of DSM-IV eating disorder were considered together. Those who had received cognitive behavior therapy or focal interpersonal therapy were doing markedly better than those who had received behavior therapy.


CONCLUSIONS
The longer-term outcome of bulimia nervosa depends on the nature of the treatment received. Patients who receive a treatment such as behavior therapy, which only has a short-lived effect, tend to do badly, whereas those who receive treatments such as cognitive behavior therapy or focal interpersonal therapy have a better prognosis.
Fairburn
C G
CG
Department of Psychiatry, University of Oxford Hospital, England.
Norman
P A
PA
Welch
S L
SL
O'Connor
M E
ME
Doll
H A
HA
Peveler
R C
RC
D000328:Adult; D000856:Anorexia Nervosa / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D001521:Behavior Therapy; D002032:Bulimia / Q000523:psychology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D011336:Probability; D011446:Prospective Studies; D011613:Psychotherapy; D012720:Severity of Illness Index; D012917:Social Adjustment; D016896:Treatment Outcome