Patients suffering from bulimia, aged 12-19, respond better to family-based treatments than supportive psychotherapy, according to an article in Archives of General Psychiatry (JAMA/Archives). Supportive psychotherapy explores the underlying issues of the disorder.

The authors wrote “Bulimia nervosa (BN) is a disabling eating disorder with a prevalence of 1 percent to 2 percent among adolescents, while another 2 percent to 3 percent of adolescents present with bulimic symptoms that are clinically significant but do not meet full threshold criteria.”

A patient with bulimia experiences episodes of bingeing (overeating), accompanied by vomiting (purging), taking laxatives, doing too much exercise, and some other inappropriate weight loss methods.

Daniel le Grange, Ph.D., University of Chicago, and team looked at 80 bulimia patients, aged 12-19 (average age 16.1) and 43 bulimic symptoms. 41 of the patients were randomly selected for family-based treatment while the other 39 received supportive psychotherapy during the period 2001-2006.

What is Family-Based Treatment?

Family-based treatment involves the parents, but does not address the underlying causes of bulimia. It aims to separate bulimics from the symptoms and empowers them to change their behaviors.

What is Supportive Psychotherapy?

Supportive psychotherapy does not include active advice for the patient that may change her eating patterns (the majority of patients are female). Rather, it helps them resolve underlying emotional issues which are thought to be at the root of the disorder.

In this study, the patients attended 20 outpatient visits over a period of six months. They were also assessed before treatments, midway through treatment, immediately following it and six months after the treatment had ended.

39% (16 total) patients receiving the family-based treatment achieved remission, compared to just 18% (total 7) patients who had received supportive psychotherapy. The writers defined remission as abstaining from binge eating and compensatory behavior immediately after treatment ended.

The authors wrote “Somewhat fewer patients were abstinent at the six-month follow-up; however, the difference was statistically in favor of family-based treatment vs. supportive psychotherapy (12 patients [29 percent] vs. 4 patients [10 percent]).”

The writers concluded “Results suggest that family-based treatment for bulimia nervosa is promising in the amelioration of symptomatic behavior for this disorder. However, we do not know whether it is family involvement or the focus on eating behavior that is key to good treatment outcome. Moreover, abstinence rates between 30 percent and 40 percent leave considerable room for improvement.”

“A Randomized Controlled Comparison of Family-Based Treatment and Supportive Psychotherapy for Adolescent Bulimia Nervosa”
Daniel le Grange, PhD; Ross D. Crosby, PhD; Paul J. Rathouz, PhD; Bennett L. Leventhal, MD
Arch Gen Psychiatry. 2007;64:1049-1056.
Click here to see abstract online

Written by: Christian Nordqvist