A randomized controlled trial of family therapy and cognitive behavior therapy guided self-care for adolescents with bulimia nervosa and related disorders.

OBJECTIVE To date no trial has focused on the treatment of adolescents with bulimia nervosa. The aim of this study was to compare the efficacy and cost-effectiveness of family therapy and cognitive behavior therapy (CBT) guided self-care in adolescents with bulimia nervosa or eating disorder not otherwise specified. METHOD Eighty-five adolescents with bulimia nervosa or eating disorder not otherwise specified were recruited from eating disorder services in the United Kingdom. Participants were randomly assigned to family therapy for bulimia nervosa or individual CBT guided self-care supported by a health professional. The primary outcome measures were abstinence from binge-eating and vomiting, as assessed by interview at end of treatment (6 months) and again at 12 months. Secondary outcome measures included other bulimic symptoms and cost of care. RESULTS Of the 85 study participants, 41 were assigned to family therapy and 44 to CBT guided self-care. At 6 months, bingeing had undergone a significantly greater reduction in the guided self-care group than in the family therapy group; however, this difference disappeared at 12 months. There were no other differences between groups in behavioral or attitudinal eating disorder symptoms. The direct cost of treatment was lower for guided self-care than for family therapy. The two treatments did not differ in other cost categories. CONCLUSIONS Compared with family therapy, CBT guided self-care has the slight advantage of offering a more rapid reduction of bingeing, lower cost, and greater acceptability for adolescents with bulimia or eating disorder not otherwise specified.

[1]  R. Shafran.  Treatment manual for anorexia nervosa: A family-based approach , 2002 .

[2]  A. O'connell.  Logistic Regression Models for Ordinal Response Variables , 2005 .

[3]  I. Eisler,et al.  Family therapy for bulimia nervosa in adolescents: an exploratory study , 1995 .

[4]  S. Bauer,et al.  Construction, scoring and validation of the Short Evaluation of Eating Disorders (SEED) , 2005 .

[5]  I. Eisler,et al.  The empirical and theoretical base of family therapy and multiple family day therapy for adolescent anorexia nervosa , 2005 .

[6]  Martin Knapp,et al.  Costing psychiatric interventions. , 1992 .

[7]  P J Cooper,et al.  The Validity of the Eating Disorder Examination and its Subscales , 1989, British Journal of Psychiatry.

[8]  U. Schmidt,et al.  The treatment of adolescents with bulimia nervosa , 2005 .

[9]  J. Beecham.  Collecting and estimating costs , 1995 .

[10]  N. Andreasen,et al.  The Longitudinal Interval Follow-up Evaluation. A comprehensive method for assessing outcome in prospective longitudinal studies. , 1987, Archives of general psychiatry.

[11]  S. Perkins,et al.  Why do adolescents with bulimia nervosa choose not to involve their parents in treatment? , 2005, European Child & Adolescent Psychiatry.

[12]  H. Doll,et al.  Risk factors for bulimia nervosa. A community-based case-control study. , 1997, Archives of general psychiatry.

[13]  J. Lindsey.  Models for Repeated Measurements , 1993 .

[14]  H. Kraemer,et al.  A multicenter comparison of cognitive-behavioral therapy and interpersonal psychotherapy for bulimia nervosa. , 2000, Archives of general psychiatry.

[15]  T J Cole,et al.  Body mass index reference curves for the UK, 1990. , 1995, Archives of disease in childhood.

[16]  Farid Kianifard,et al.  Models for Repeated Measurements , 2001, Technometrics.

[17]  Robert Tibshirani,et al.  An Introduction to the Bootstrap , 1994 .

[18]  J. Treasure,et al.  First step in managing bulimia nervosa: controlled trial of therapeutic manual. , 1994, BMJ.

[19]  I. Eisler,et al.  Family therapy for adolescent anorexia nervosa: the results of a controlled comparison of two family interventions. , 2000, Journal of child psychology and psychiatry, and allied disciplines.