Bulimia Nervosa: Comparative Efficacy of Available Psychological and Pharmacological Treatments

This report evaluates the comparative efficacy of available treatments for bulimia nervosa and extends on a previous report ECRI Institute published in 2006 titled Bulimia Nervosa: Efficacy of Available Treatment, which is available in full on the Bulimia Nervosa Resource Guide website (www.bulimiaguide.org). Unlike the previous report, this report considers only studies in which one treatment is directly compared to another treatment. Thus, we do not consider evidence from studies that compare an active treatment to a placebo or no treatment control condition. The primary treatments of interest to this report are pharmacotherapy, cognitive behavioral therapy, other psychotherapies, and combinations of these therapies. This report does not consider other eating disorders, such as anorexia nervosa or binge eating disorder.

Bulimia nervosa (BN) is characterized by recurrent episodes of binge eating (the consumption of a large amount of food accompanied by a sense of a loss of control) followed by recurrent use of extreme compensatory behaviors such as self-induced vomiting; misuse of laxatives, diuretics, enemas, or other medications; and fasting or excessive exercise to prevent weight gain. In addition, the affected person’s perceptions about his/her body shape and weight exert undue influence on self-esteem and self-evaluation.

This report evaluates the comparative efficacy of available treatments for BN. The primary treatments of interest to this report are pharmacotherapy, cognitive behavioral therapy (CBT), other psychotherapies, and combinations of these therapies. This report does not consider other eating disorders, such as anorexia nervosa or binge eating disorder.

Treatment for BN can be provided in an inpatient or outpatient setting. In 2007, ECRI Institute identified 140 centers that provide inpatient and/or outpatient treatment for individuals with BN. These centers, along with information about their treatment philosophies, treatment approaches, staffing, and the clinical...