Interrupting the binge-purge cycle in bulimia: the use of planned binges

Test-retest reliability and discriminant validity of the Restraint Scale translated into Portuguese

The aim of this study was to evaluate reliability and discriminant validity of the Restraint Scale (RS) translated into Portuguese. The version was obtained through a process of translation and back translation. Women with eating disorders (n = 39: 24 bulimics and 15 anorexics) and students without eating disorders (n = 57) filled the scale. It was hypothesized that if the scale has any discriminant validity, the bulimic scores should differ from those of the students and the anorexics. The questionnaire was applied twice to the controls with 1-month interval to evaluate test-retest stability. Bulimics obtained a score of 28.1 +/- 13 (significantly different from students and anorexics), anorexics obtained 17.3 +/- 9 (significantly different from students), and students 11.3 +/- 5. Body mass index (BMI) was significantly correlated to dietary restraint, especially among controls. Test-retest correlation coefficient was .64 (P = .000001). The RS translated into Portuguese seems to be a valid and reliable instrument, which can be used in many studies of eating behaviors.

Treatment of bulimia nervosa: when CBT fails

Controlled studies have established manual-based cognitive-behavioral therapy (CBT) is the first-line treatment of choice for bulimia nervosa. Nevertheless, its effectiveness is limited. On average, only 50% of patients cease being eating and purging. Of the remainder, some show partial improvement, whereas a small number derive no benefit at all. In treating nonresponders to CBT one option would be to use antidepressant medication. A second would be to adopt interpersonal psychotherapy (IPT), an alternative psychological therapy with empirical support. However, both options have failed to reduce binge eating following unsuccessful CBT. Treating nonresponders is hampered by the lack of treatment-specific predictor variables. Comorbid personality disorder is associated with a poorer response not only to CBT but also alternative therapies. There is no evidence that psychodynamic therapy is effective with complex cases with associated psychopathology. A third option is to use more expanded or intensive CBT. An example of the latter would be concentrated exposure within an inpatient setting. The relative merits of adhering to manual-based treatment versus allowing therapists free reign in individual case formulation are discussed.