Innovative treatment approaches to bulimia nervosa

Psychiatric comorbidity of bulimia nervosa inpatients: relationship to clinical variables and treatment outcome

Experimental evidence suggesting that psychiatric comorbidity has important clinical and prognostic implications in bulimia nervosa has mostly been based on outpatient studies investigating a selection of co-existing psychopathological features with rather unstructured and not standardized diagnostic instruments. Using structured instruments (SCID-P, MDCL) for the diagnoses of DSM III-R axis I disorders and clinical interviews for the diagnosis of DSM III-R axis II disorders in 24 hospitalized bulimics, the present study demonstrated that more than half of the patients had two or three axis I disorders in addition to bulimia nervosa and almost half of the patients met criteria of at least one personality disorder. Subgroups of patients classified according to the type of psychiatric comorbidity did not differ significantly with respect to clinical features; regarding measures of hospital behavior therapy outcome. However, the findings provided evidence for a negative impact of anxiety disorder in addition to bulimia nervosa on the improvement of bulimic behavior and possibly also on self-rated depression.

Exposure makes the heart grow less fond!: the effects of exposure to palatable foods on the subsequent attention processing of food cues

Prior research has provided conflicting evidence on the question of whether exposure to food temptations directs attention towards or away from food cues. In this study, the effects of exposure to food temptations on attention processing were investigated using an exogenous cueing paradigm. The results show that exposure to food temptations led participants to direct their attention away from food cues. This effect was found after exposure to pictures of food as well as real food temptations. These findings suggest that food temptations activate a tendency to avoid food stimuli, regardless of the restraint and disinhibition levels of the participants.

Duration of bulimia nervosa and symptom progression: a retrospective analysis of treatment-seeking bulimics

Severity of bulimia nervosa upon presentation for treatment may be influenced by duration and age of onset of bulimic behaviors. This hypothesis was investigated in a retrospective study by correlating duration of bulimia and age of onset with sets of variables measuring the primary symptoms and other psychopathology associated with bulimia nervosa. The experimental design was cross-sectional. The sample included 153 women who had been diagnosed with bulimia nervosa. Canonical correlations indicated that younger age of onset and longer duration were associated with more severe bulimic symptoms and increased body image distortion. Anorexic symptoms were reduced over time, however, and weight gain (at a rate of about 0.54 Kg [1.2 lbs] per year) was correlated with duration of bulimic behaviors. Also, older age of onset and longer duration were associated with increasing social introversion. These findings were interpreted as supportive of the hypothesis that younger age of onset and longer duration of bulimic behaviors are associated with more severe bulimia and general psychopathology. Though limited by the retrospective nature of the study, these results substantiate the need for longitudinal investigations of bulimia nervosa.

An uncontrolled evaluation of inpatient and outpatient cognitive-behavior therapy for bulimia nervosa

Inpatient (n = 27) and outpatient (n = 22) cognitive-behavior therapy programs for bulimia nervosa were evaluated in an uncontrolled experiment. Both treatment conditions included exposure with response prevention and cognitive restructuring. Inpatient treatment had a mean length of stay of 5 weeks. Outpatient treatment lasted 15 weeks. Both groups were followed after the end of treatment. The results showed that both programs were effective in reducing problems associated with bulimia nervosa. The inpatient program led to very rapid progress, whereas the outpatient program led to more gradual improvement. There was, however, a trend toward relapse for inpatients. Other psychological disturbances, (e.g., depression) were improved after inpatient, but not outpatient, treatment. These data were discussed in terms of their implications for treatment planning for cases of bulimia nervosa.