“Abstinence” and “nonabstinence” models for the treatment of bulimia

Abstract

One of the most controversial dimensions along which developing therapeutic approaches for bulimia can be differentiated is their allegiance to an “abstinence” or “nonabstinence” model. Through analogy to traditional treatment programs for chemical dependency, many self‐help and professional programs for bulimia hold that the complete elimination of binge‐vomiting behavior is a prerequisite for therapeutic work, and require abstinence from the inception of treatment. In contrast, the nonabstinence model suggests that a more gradual reduction in the frequency of episodes may be preferable in that it provides more opportunities for relapse prevention training and avoids reinforcing dichotomous thinking styles. The present paper reviews the theoretical and clinical arguments that have been advanced by each side, including the case for classifying bulimia as a substance abuse disorder. A strategy for investigating the relative efficacy of the two approaches is proposed. It is suggested that particular attention be paid to such variables as differential attrition, the effect of each modality on the accuracy of self‐report, the need for continuing or supplementary therapy, the occurrence of treatment “casualties,” interactions between client characteristics and mode of therapy, and long‐term results. In the interim before such data are available, a reasonable clinical recommendation may be the implementation of a “compromise” approach designed to maximize the advantages claimed by each model while minimizing possible risks.

Risk Factors for Eating Disorders

“…From these statistical associations, researchers then delineated hypotheses about a causal relationship between the risk factor and the disorder 16 . The early literature suggested associations between the development of an eating disorder and race (being Caucasian), high socioeconomic status, family dysfunction, perfectionism, low self‐esteem, high need for social approval, participation in a social network in which thinness was particularly valued, experiencing an anxiety disorder (particularly obsessive–compulsive disorder in AN and social phobia in BN), and depression 16,38 …”

Effectiveness of the intensive group process-retreat model in the treatment of bulimia

“…According to Bemis (1985), the "design of treatment programs for bulimia is equivalent to a leap of faith. It requires an unwarranted but perhaps adaptive confidence in the accuracy of one's conceptual framework or the acuity of one's clinical insight" (p. 433).…”

“…According to Bemis (1985) research is needed that reviews treatment outcome in "abstinence" and "nonabstinence" models for bulimia, (d) documentation of the effectiveness of group therapy for bulimia on other measures than symptomatic eating, and (e) the effects of an intensive group treatment on subjects who self-select a clinical treatment in a private practice setting rather than a university, or hospital based program.…”

Eating Motivations and Bulimic Behavior among College Women

“…Although many authors have attempted to make a case for similarities between bultmia and various substance abuse disorders (Hatsukami, et a[., 1982), others have warned that a simple overlap of symptoms is insufficient to justify the conclusion that the underlying dynamics are the same (Bemis, 1985). It is important in making such comparisons to identify points of similarity beyond similar symptom patterns and general personality characteristics, to identdy common aspects of specific etiological significance.…”