Treatment of Bulimia Nervosa

Abstract

The treatment for bulimia nervosa is considered under three broad categories: psychological, pharmacological and combination therapies. It is suggested that there is not one treatment which will benefit allpatients and that a stepped care aproach to treatment allows a rational application of current knowledge. One possible programme of stepped care is outlined, which allows the pragmatic application of current therapeutic techniques within a structured framework.Int Rev Psychiatry Downloaded from informahealthcare.com by UB Giessen on 12/15/14 For personal use only. Int Rev Psychiatry Downloaded from informahealthcare.com by UB Giessen on 12/15/14 For personal use only. Women attending a selfhelp group for anorexia nervosa and bulimia: views on self-help and professional treatment, British Review of

Dropping Out from Psychological Treatment for Eating Disorders: What are the Issues?

“…Surprisingly, descriptions often do not include information about dropping out (Doyle, 1995;Fairburn, 1996), even though levels of engagement would seem to be an important consideration. An exception is a paper reviewing treatments and presenting a stepped treatment programme which incorporates interventions to reduce dropping out (Tiller et al, 1993); however, rates are not specified.…”

Beyond effectiveness and efficiency lies quality in services for eating disorders

“…An alternative approach to clinical algorithms of care is to have treatment arranged in a series of steps of graded intensity. A sequential model was recommended in the Royal College of Psychiatrists' Report in 1992 and several alternative models have been described, all of which suggest that a series of treatments increasing in intensity are offered in a stepped fashion (Agras, 1993;Fairburn and Peveler, 1990;Fairburn et al, 1992;Garner et al, 1986;Garner and Needleman, 1997;Tiller et al, 1993). The advantage of such an approach is that it does not waste resources in that those who respond to a minimal intervention are`®ltered out' at the earliest possible stage.…”

Family therapy for bulimia nervosa in adolescents: an exploratory study

“…Much attention has been given to the evaluation of treatment for adults with bulimia nervosa. Pharmacological, nutritional and cognitive behavioural therapy have come to dominate research in the field (Freeman, 1991;Tiller et al, 1993). Although significant improvement is claimed in many treatment studies it is becoming clearer that the majority of subjects still have some symptoms on completion of treatment (Mitchell, 1991;Tiller et al, 1993).…”

“…Pharmacological, nutritional and cognitive behavioural therapy have come to dominate research in the field (Freeman, 1991;Tiller et al, 1993). Although significant improvement is claimed in many treatment studies it is becoming clearer that the majority of subjects still have some symptoms on completion of treatment (Mitchell, 1991;Tiller et al, 1993). Recently Fairburn and colleagues ( 1993) have reported that an interpersonal Family therapy f o r bulimia in adolescents 61 form of psychotherapy has long-term outcome results as good as those achieved with cognitive behavioural therapy.…”