Patients with bulimia nervosa who fail to engage in cognitive behavior therapy.
Although cognitive behavioral treatment is the treatment of choice in bulimia nervosa, patients' response is variable. A minority of patients do not respond at all and some never engage in treatment. This paper concerns the latter group. A case series of six such patients with whom treatment could not be initiated is compared with a group who received a full course of treatment. The group with whom treatment could not begin were found to have a longer history of disorder, to report excessive laxative abuse, to have more severe depressed mood and a greater dissatisfaction with their body weight. In addition, they were more likely to have abused psychoactive substances, engaged in episodes of self-harm, and have a lower self-esteem. They were also more likely to be diagnosed as having borderline personality disorder. Patients presenting with the wide range of difficulties characteristic of this group require a more intensive form of treatment than standard outpatient cognitive behavior therapy.
Coker
S
S
Department of Psychiatry, University of Cambridge, U.K.
Vize
C
C
Wade
T
T
Cooper
P J
PJ
D000293:Adolescent; D000328:Adult; D000856:Anorexia Nervosa / Q000523:psychology / Q000628:therapy; D001828:Body Image; D001835:Body Weight; D002032:Bulimia / Q000523:psychology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy; D004038:Diet, Reducing / Q000523:psychology; D005260:Female; D006801:Humans; D010349:Patient Compliance / Q000523:psychology; D010352:Patient Dropouts / Q000523:psychology*; D019966:Substance-Related Disorders / Q000150:complications / Q000523:psychology