Bulimia nervosa in adolescents: a new therapeutic frontier

Abstract

Enhanced cognitive behaviour therapy (CBT-E) is the first-line treatment for bulimia nervosa (BN) in adulthood. There is limited evidence for therapies for children and adolescents with BN; however family-based treatment (FBT) is being increasingly used. This case study contrasts the delivery of FBT with an augmented version (CBT-E) in two adolescents presenting with BN. In both cases, the adolescents achieved remission from BN symptoms, (cessation of bingeing and compensatory behaviour) at the end of treatment. The families reported that FBT provided a platform for them to work together and view BN as a family issue, rather than leaving the onus on the young person to recover independently. The addition of CBT-E strategies assisted with managing cognitions associated with bodyweight and shape concerns and appeared to be useful in a more complex presentation with comorbidities. Future research should examine the effectiveness of augmenting CBT-E strategies to FBT using larger samples and more rigorous research designs.Practitioner points • Involving families in the treatment of adolescent BN is both effective and acceptable to young people and their families. • Two promising treatment approaches, FBT-BN and CBT-E, can effectively be combined to provide a therapy which has the strengths of both modalities alone. • Adolescents with comorbidities or complex presentations may benefit most from combining the two modalities to develop additional skills and strategies.

Canadian practice guidelines for the treatment of children and adolescents with eating disorders

“…For AN, three case series [70][71][72] and two case reports [73,74] indicate improved weight and psychological symptoms with added modules on perfectionism or exposure ( Table 7). For BN, one case control study exists that compared one patient treated with FBT plus CBT to another patient treated with FBT alone, finding that both patients improved in terms of binge/purge symptoms and Eating Disorder Examination (EDE) scores [75] (Table 8).…”

A systematic review of cognitive behavior therapy and dialectical behavior therapy for adolescent eating disorders

“…Adolescents had significantly lower satisfaction with care across treatments compared to parents, though a non-significant trend favored adolescent satisfaction with CBT outpatient care compared to general community care Fair a Hilbert et al (2020) [ 47 ] RCT BED 15.3 [12–20] CBT (32) vs WLC (36) 32 20 sessions over 4 mo 6 mo 12 mo 24 mo Compared to WLC group, CBT group had significantly higher rates of abstinence from binge eating (51% vs. 33%) and remission from BED (57% vs. 33%) and significantly less ED psychopathology at EOT (EDE). CBT group maintained its advantage relative to WLC in in ED behaviors and psychopathology at all FU timepoints Good a Hurst et al (2017) [ 83 ] Case study BN 15 [15–15] FBT-BN (1) versus FBT-BN + CBT (1) 0 Not reported None Participants in both treatments achieved full remission at EOT (EDE global score within 1 SD of community norms). Participant 1 reduced binge and purge episodes from an average of 12 per week at BL, to 100% abstinence at EOT.…”