Bulimia nervosa treatment: a systematic review of randomized controlled trials.
OBJECTIVE
The RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center systematically reviewed evidence on efficacy of treatment for bulimia nervosa (BN), harms associated with treatments, factors associated with treatment efficacy, and differential outcome by sociodemographic characteristics.


METHODS
We searched six major databases published from 1980 to September 2005 in all languages against a priori inclusion/exclusion criteria; we focused on eating, psychiatric or psychological, and biomarker outcomes.


RESULTS
Forty-seven studies of medication only, behavioral interventions only, and medication plus behavioral interventions for adults or adolescents met our inclusion criteria. Fluoxetine (60 mg/day) decreases the core symptoms of binge eating and purging and associated psychological features in the short term. Cognitive behavioral therapy reduces core behavioral and psychological features in the short and long term.


CONCLUSIONS
Evidence for medication or behavioral treatment for BN is strong, for self-help is weak; for harms related to medication is strong but either weak or nonexistent for other interventions; and evidence for differential outcome by sociodemographic factors is nonexistent. Attention to sample size, standardization of outcome measures, attrition, and reporting of abstinence from target behaviors are required. Longer follow-up intervals, innovative treatments, and attention to sociodemographic factors would enhance the literature.
Shapiro
Jennifer R
JR
Department of Psychiatry, University of North Carolina at Chapel Hill, North Carolina 27599-7160, USA.
Berkman
Nancy D
ND
Brownley
Kimberly A
KA
Sedway
Jan A
JA
Lohr
Kathleen N
KN
Bulik
Cynthia M
CM
D052018:Bulimia Nervosa / Q000628:therapy*; D006801:Humans; D016032:Randomized Controlled Trials as Topic