Outcome in bulimia nervosa

Abstract

A lthough binge eating and purging were observed in women with anorexia nervosa, bulimia nervosa is a relatively recent addition to the medical literature, having been first described in 1979 (1). Consistent with the negative impact that binge eating and purging were observed to have on anorectic patients' outcome (2), bulimia nervosa was termed "an ominous variant of anorexia nervosa." This dire description was tempered with the recognition that "only a brief comment on the prognosis of bulimia nervosa is appropriate, for long-term follow-up studies have not been undertaken" (1). Now, more than 15 years later, little additional information seems available. A single study of 44 women diagnosed with bulimia nervosa 10 years earlier (3) provides the only available data on long-term outcome. Indeed, DSM-IV states, "The long-term outcome of Bulimia Nervosa is not known."Comparing and summarizing results across those outcome studies which do exist are complicated by methodological differences among and within studies. For example, one study (4) employed four different measures of eating disorder outcome in order to attribute differences in recovery estimates to the impact of assessment methods. That study found that the range of those considered recovered was 29% to 42%. Thus, inconsistent findings across studies may be partially attributed to differences in methods of assessment, as well as sample characteristics, definitions of terms, and ascertainment rates.The limited availability and comparability of research findings leave the following questions largely unanswered: What is the long-term physical, psychological, and psychosocial outcome among women diagnosed with bulimia nervosa? What percentage of women re-

Different Moderators of Cognitive-Behavioral Therapy on Subjective and Objective Binge Eating in Bulimia Nervosa and Binge Eating Disorder: A Three-Year Follow-Up Study

“…Considering that longitudinal studies on this field adopted either binge eating reduction or diagnostic change as outcome measures [4,28,29,30,31,44], we used two different models to analyze data, according to dimensional (binge eating reduction) and categorical approaches (recovery). …”

“…Furthermore, different longitudinal studies suggest that the considered clinical variables have a different effect on treatment outcome for the two syndromes: a low remission rate of binge eating episodes has been associated with the severity of body dissatisfaction [28], depression [4], and impulsivity for BN [29,30], and with binge eating [31] and emotional eating at baseline [32] for BED. According to the above-considered studies and theories, eating core psychopathology, impulsivity and mood modulatory mechanisms would show a different pattern of association between BN and BED patients, and could act as different moderators of treatment effects in the two syndromes [33].…”

Dimensions of impulsivity in relation to eating disorder recovery

“…Higher levels of impulsivity are associated with poorer outcomes from BN, 9 and case study intervention work found that reduced impulsivity preceded decreased binge eating, 10 suggesting a link between impulsivity and recovery. Some evidence associates the novelty seeking aspect of impulsivity with recovery from AN; due to the rigidity involved in restriction in AN, decreased inhibition may aid in recovery.…”

The Sequential Binge, a New Therapeutic Approach for Binge Eating: A Pilot Study

“…This model included daily number of binges as the dependent variable and the following independent variables: (1) number of binges the previous day, (2) use of SB (“SB day” vs. “no-SB day” during the pre-SB period vs. “no-SB day” in the post-SB period), (3) interaction between (1) and (2), (4) age at first diagnosis [26,43], (5) time elapsed between first diagnosis and SB presentation [43], (6) diagnosis (AN versus BN and BED together) [44], (7) co-morbidities associated with impulsivity or mood [23] (presence/absence of substance–related, major depressive, bipolar or borderline personality disorder), and (8) educational level [24]. Participants were set as a random factor over the intercept.…”