Bulimia nervosa cognitive-behavioral therapy

Bulimic patients have a low mortality rate, but they may suffer the consequences of electrolyte disturbances if they engage in frequent and/ or aggressive purges. The electrolyte disturbances can cause fatigue, seizures, and death in extreme cases. Unlike anorexia nervosa, studies have shown that specific treatments can be effective in bulimia nervosa. Cognitive-behavioral therapy (CBT) is one such intervention, with reported remission rates of 25-50% for bulimic patients (Walsh, 2001). The most effective medications are the SSRIs, which typically require antiobsessional doses to be effective. Often the therapist will want to start with CBT, and if this is not sufficiently effective alone, then consultation can be obtained to add an SSRI to the treatment regimen. 

Agras, W., Rossiter, E.M., Arnow, and Schneider, J.A. (1992) Pharmacologic and cognitive-behavioral treatment for bulimia nervosa a controlled comparison. Am J Psychiatry 149 82-87. Agras, W., Walsh, B.T., Fairburn, C., Wilson, G.T., Kraemer, H. (1999) A multicenter comparison of cognitive-behavioral therapy an interpersonal psychotherapy for bulimia nervosa. 

Fairburn, C., Jones, R., Peveler, R., and Hope R. (1993) Psychotherapy and bulimia nervosa longer-term effects of interpersonal therapy, behavior therapy and cognitive behavioral therapy. Arch Gen Psychiatry 50 419 28. 

Agras, W. S., T. Walsh, C. G. Fairbum, G. T. Wilson and H. C. Krae-mer (2000). A multicenter comparison of cognitive-behavioral therapy and interpersonal psychotherapy for bulimia nervosa. Arch Gen Psychiatry 57(5) 459-66. 

Goldbloom, D. S., M. Olmsted, R. Davis, J. Clewes, M. Heinmaa, W. Rockert, et al. (1997). A randomized controlled trial of fluoxetine and cognitive behavioral therapy for bulimia nervosa short-term outcome. Behav Res Ther 35(9) 803-11. 

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