The finding that nonspecific supportive clinical management was superior to more specialized psychotherapies was opposite to the primary hypothesis and challenges assumptions about the effective ingredients of successful treatments for anorexia nervosa.

Possible effective components of SSCM are discussed.

A link between cesarean section and postpartum depression has not been established.

The authors attempted to replicate previous findings that weight suppression is a significant predictor of treatment completion and treatment outcome (M. L. Butryn, M. R. Lowe, D. L. Safer, & W. S. Agras, 2006) and weight gain over treatment (M. R. Lowe, W. Davis, D. Lucks, R. A. Annunziato, & M. L. Butryn, 2006) among women with bulimic disorders. The authors also examined 2 alternative measures of weight variability. Participants were 132 women with bulimia nervosa treated with cognitive-behavioral therapy. Participants who dropped out of treatment did not have significantly higher levels of weight suppression than did treatment completers. Among those who completed treatment, weight suppression did not significantly predict binge eating and purging at post-treatment. Weight suppression did significantly predict weight change and, in particular, weight gain (>/=5 kg) over treatment. Alternative measures of weight variability did not significantly predict treatment completion or treatment outcome, but 1 measure significantly predicted weight gain over treatment. In conclusion, the authors failed to replicate the previous finding that weight suppression predicts treatment compliance and treatment outcome, but they did replicate the finding that weight suppression predicts weight gain over treatment.

Objective: To evaluate the long-term efficacy of three psychotherapies for anorexia nervosa.Method: Participants were women with broadly defined anorexia nervosa who had participated in a RCT comparing specialized psychotherapies (cognitive behavior therapy, CBT, and interpersonal psychotherapy, IPT) with a control condition (specialist supportive clinical management, SSCM), and attended long-term follow-up assessment (mean 6.7 years 6 1.2).Results: Forty three of the original sample of 56 women participated in longterm follow-up assessment (77%). No significant differences were found on any pre-selected primary, secondary or tertiary outcome measures among the three psychotherapies at long-term follow-up assessment. Significantly different patterns of recovery were identified for the psychotherapies across time on the primary global outcome measure. Although SSCM was associated with a more rapid response than IPT, by follow-up all three treatments were indistinguishable.Discussion: Potential implications for the timing of interventions to improve treatment response in anorexia nervosa are critically examined. V V C 2010 by Wiley Periodicals, Inc.

We examined predictors of outcome 1 year after completion of a randomized clinical trial assessing the additive efficacy of two forms of exposure with response prevention to a core of cognitive-behavioral therapy (CBT) for bulimia nervosa (BN). One hundred one women who met DSM-III-R criteria for BN, and who completed the clinical trial, were available for follow-up at 1 year. Predictor variables were assessed prospectively and partitioned temporally to reflect lifetime history (including personality), pretreatment clinical status, and posttreatment clinical status. Outcome was based on the frequency of binging and purging in the 3 months before assessment based on carefully constructed lifechart interviews. A series of stepwise logistic regressions were performed to determine independent predictors of 1-year outcome while controlling for treatment received. Demographic variables were unrelated to treatment outcome. A history of obesity was predictive of poor outcome, whereas a history of alcohol dependence decreased the odds of poor outcome. High self-directedness on the Temperament and Character Inventory (TCI) predicted favorable outcome at 1 year, whereas personality disorder symptoms were not predictive. Pretreatment global functioning, bulimia scores on the Eating Disorders Inventory (EDI), and the presence of major depression predicted poor outcome. Posttreatment binging, food restriction, and urges to binge on a cue reactivity assessment predicted poor outcome at 1 year. The character trait of self-directedness is a strong predictor of good outcome for CBT, and methods to enhance this trait may be worthy of investigation. Low global functioning and the presence of major depression at presentation may require additional treatment than focused CBT for BN. Our results argue for treatment goals that include abstinence from binging and restricting and decreases in urges to binge in response to high-risk cues.

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We examined the prevalence and ages at onset of additional childhood and adult psychiatric disorders in women with bulimia nervosa and evaluated the differential impact of a mood or anxiety disorder on the presentation of bulimia nervosa. One hundred fourteen women participating in a clinical trial of cognitivebehavioral therapy for bulimia nervosa were assessed at pretreatment with structured diagnostic methodology. Although mood disorders were the most frequently occurring additional psychiatric disorder (75%), 64% experienced an additional anxiety disorder. Age at onset of the anxiety disorders was markedly earlier than age at onset of bulimia nervosa or other comorbid conditions. Stratification of the sample on the pres-ence of a mood or anxiety disorder revealed no differences in the core bulimic symptoms across groups. The presence of a mood disorder was associated with greater body dissatisfaction, lower Global Assessment of Functioning Scales (GAFS) score, more externalizing disorders of childhood, and, as expected, higher Hamilton Depression Rating Scale (HDRS) scores. The presence of an anxiety disorder was related to a history of anorexia nervosa and earlier age at onset of drug or alcohol dependence. Early-onset anxiety disorders are prevalent and may represent one potential pathway to bulimia nervosa.