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By: Cynthia M. Bulik, PhD, FAED and Nancy D. Berkman, PhD, MLIR
"Anorexia Nervosa
For adults, preliminary evidence suggested that cognitive behavioral therapy may reduce the relapse risk after weight restoration. For adolescents, evidence supported specific forms of family therapy that initially focused on parental control of renutrition.
Among anorexia nervosa patient populations, at least one-half no longer suffered from anorexia nervosa at follow up, but many continued to have other eating disorders; mortality was significantly higher than would be expected in the population. Factors associated with recovery or good outcomes were lower levels of depression and compulsivity. Factors associated with mortality included concurrent alcohol and substance use disorders.
Bulimia Nervosa
The medication-only literature supported fluoxetine (60 mg/day) administered for 6 to 18 weeks in terms of short-term reductions in binge eating, purging, and psychological features. The 60 mg dose performed better than lower doses and was associated with prevention of relapse at 1 year. Long-term effectiveness of fluoxetine is unclear. Cognitive behavioral therapy administered individually or in groups reduced core symptoms of binge eating, purging, and psychological features in both the short and the long term. How best to treat individuals who do not respond to cognitive behavioral therapy or fluoxetine is unknown.
Generally, more than one-half of patients no longer suffered from this diagnosis at the end of various studies. A substantial percentage continued to suffer from other eating disorders; depression was related to worse outcomes. Bulimia nervosa was not associated with increased mortality.
Binge Eating Disorder
Our systematic review focused on outcomes related to binge eating and weight change in overweight individuals. Selective serotonin reuptake inhibitors (SSRIs) decreased target eating, psychiatric and weight symptoms, and severity of illness. However, studies were often short, and we could not determine whether observed improvements persisted after patients discontinued the medication. Cognitive behavioral therapy alone was associated with decreased binge eating. What remains unclear is whether this type of intervention helps with depressed mood, and it apparently does not produce decreases in weight. Self-help led to decreases in binge eating and negative psychological features, and rates of abstinence from binge eating were comparable to those in face-to-face psychotherapy. "
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