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Latest Research on Bulimia
     
Eat Disord. 2008 Jan-Feb;16(1):52-72.
Experiences of women with bulimia nervosa in a mindfulness-based eating disorder treatment group.
Proulx K.
University of Massachusetts, Amherst, Massachusetts, USA.

The experience of 6 college-age women with bulimia nervosa was examined after they participated in an 8-week mindfulness-based eating disorder treatment group. This phenomenological study used individual interview and pre- and post-treatment self-portraits. Participants described their experience of transformation from emotional and behavioral extremes, disembodiment, and self-loathing to the cultivation of an inner connection with themselves resulting in greater self-awareness, acceptance, and compassion. They reported less emotional distress and improved abilities to manage stress. This treatment may help the 40% of women who do not improve with current therapies and might be useful to prevent symptoms in younger women.

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Eat Disord. 2008 Jan-Feb;16(1):30-9.
Parental psychopathology as a predictor of long-term outcome in bulimia nervosa patients.
Arikian A, Keel PK, Miller KB, Thuras P, Mitchell JE, Crow SJ.
Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota, USA.

This paper sought to examine parental variables as predictors of long-term outcome in women with bulimia nervosa (BN). Participants were 94 treatment-seeking women with BN who were assessed at baseline, treatment end, and at follow-up (M=10.13 years). Participants reported rates of psychopathology and obesity in their mothers and fathers at baseline. The most frequently reported parental psychopathology was substance abuse in fathers. Chi-square analyses indicated that substance abuse in fathers was associated with poor treatment-end outcome in BN participants. Depression in mothers was associated with poor outcome at long-term follow-up, and obesity in mothers was associated with better outcome at long-term follow-up. A logistic regression analysis found that lifetime mood disorder in participants and severe depression in mothers were independent predictors of bulimic symptoms at long-term follow-up. The association between maternal severe depression and long-term outcome in BN suggests that specific parental variables may indicate longer course of BN.

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Psychother Psychosom. 2008;77(1):57-60. Epub 2007 Dec 14.
Repetitive transcranial magnetic stimulation in bulimia nervosa: preliminary results of a single-centre, randomised, double-blind, sham-controlled trial in female outpatients.
Walpoth M, Hoertnagl C, Mangweth-Matzek B, Kemmler G, Hinterhölzl J, Conca A, Hausmann A.
Department of General Psychiatry, Innsbruck Medical University, Innsbruck, Austria. Michaela.Walpoth@i-med.ac.at

BACKGROUND: Bulimia nervosa (BN) is often associated with depressive symptoms and treatment with antidepressants has shown positive effects. A shared deficient serotonergic transmission was postulated for both syndromes. The left dorsolateral prefrontal cortex was argued to regulate eating behaviour and to be dysfunctional in eating disorders. METHODS: Fourteen women meeting DSM-IV criteria for BN were included in a randomised placebo-controlled double-blind trial. In order to exclude patients highly responsive to placebo, all patients were first submitted to a one-week sham treatment. Randomisation was followed by 3 weeks of active treatment or sham stimulation. As the main outcome criterion we defined the change in binges and purges. Secondary outcome variables were the decrease of the Hamilton Depression Rating Scale (HDRS), the Beck Depression Inventory (BDI) and the Yale-Brown Obsessive Compulsive Scale (YBOCS) over time. RESULTS: The average number of binges per day declined significantly between baseline and the end of treatment in the two groups. There was no significant difference between sham and active stimulation in terms of purge behaviour, BDI, HDRS and YBOCS over time. CONCLUSION: These preliminary results indicate that repetitive transcranial magnetic stimulation (rTMS) in the treatment of BN does not exert additional benefit over placebo. A larger number of patients might clarify a further role of rTMS in the treatment of BN. 2008 S. Karger AG, Basel

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Int J Eat Disord. 2007 Nov 20 [Epub ahead of print]
Eating disorder symptoms in pregnancy: A prospective study.
Crow SJ, Agras WS, Crosby R, Halmi K, Mitchell JE.
Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota.

Previous work suggests that eating disorder symptoms diminish with pregnancy. However, little prospective study has been conducted, and little is known about pregnancy symptoms in eating disorder not otherwise specified.OBJECTIVE:: To prospectively study both eating behaviors and disordered eating cognitions in pregnant women with various eating disorder diagnoses. METHOD:: Forty-two participants became pregnant during 4-year follow-up of 385 women with full or subthreshold anorexia nervosa, bulimia nervosa, or binge eating disorder. Participants completed the Eating Disorders Examination (EDE) at 6-month intervals. Mixed modeling procedures were used to examine change in eating disorder cognitions, binge eating, and purging. RESULTS:: EDE restraint, EDE shape concerns, EDE weight concerns, binge eating, and purging diminished from prepartum to intrapartum, but returned to approximately baseline levels postpartum. CONCLUSION:: In this longitudinal sample of women with diverse
eating disorder diagnoses, eating disorder symptoms improved during pregnancy, but worsened postpartum. These results highlight pregnancy as a potential time for eating disorder interventions. (c) 2007 by Wiley Periodicals, Inc. Int J Eat Disord 2007.

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Int J Eat Disord. 2007 Oct 5 [Epub ahead of print]
A critical evaluation of the efficacy of self-help interventions for the treatment of bulimia nervosa and binge-eating disorder.
Sysko R, Walsh BT.
Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, New York.

OBJECTIVE:: Cognitive behavioral therapy (CBT) is efficacious for the treatment of bulimia nervosa (BN) and binge-eating disorder (BED). As a number of factors limit the availability of CBT, self-help manuals have been developed to make the treatment more widely available. METHOD:: Published studies evaluating the efficacy of self-help programs in the treatment of BN and BED were reviewed. RESULTS:: Controlled studies of self-help programs for BN and BED have often employed a waiting list control group, and indicate that self-help provides more benefit than remaining on a waiting list. However, fewer studies have utilized a more active control group, and these studies have not been as positive. CONCLUSION:: In general, open and wait-list trials indicate that self-help is helpful in treating BN and BED, but there is little evidence for the specific efficacy of self-help in comparison to other treatments. Additional studies of self-help are needed to determine the specific utility of self-help interventions for BN and BED. (c) 2007 by Wiley Periodicals, Inc. Int J Eat Disord 2007.

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Aust Fam Physician. 2007 Sep;36(9):708-12, 731.
Understanding bulimia.
Hay PJ.
Discipline of Psychiatry, School of Medicine, James Cook University, Townsville, and The Institute of Psychiatry, The Townsville Hospital, New South Wales, Australia. p.hay@uws.edu.au

BACKGROUND: Bulimia nervosa (BN) and related eating disorders such as binge eating disorder are common. General practitioners can play a key role in the identification and management of BN and related eating disorders. OBJECTIVE: This article describes the presenting and associated features of BN and overviews evidence based treatment approaches. DISCUSSION: Key features are recurrent episodes of binge eating, extreme weight control behaviours and over concern about weight and shape issues. By definition people are not underweight. Risk factors include being from a western culture, obesity, exposure to a restrictive dieting environment and low self esteem. People are more likely to present asking for help in weight control or a physical problem secondary to the eating disorder. Evidenced based therapies with good outcomes in current use are cognitive behaviour therapy (in full or guided self help forms), high dose fluoxetine, and interpersonal psychotherapy. It is important t
o convey optimism about treatment efficacy and outcomes.

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J Clin Psychiatry. 2007 Sep;68(9):1324-32.
Double-blind, randomized, placebo-controlled trial of topiramate plus cognitive-behavior therapy in binge-eating disorder.
Claudino AM, de Oliveira IR, Appolinario JC, Cordás TA, Duchesne M, Sichieri R, Bacaltchuk J.
Department of Psychiatry, Universidade Federal de São Paulo, Brazil. angelica@psiquiatria.epm.br

OBJECTIVE: To evaluate the efficacy and tolerability of adjunctive topiramate compared to placebo in reducing weight and binge eating in obese patients with binge-eating disorder (BED) receiving cognitive-behavior therapy (CBT). METHOD: A double-blind, randomized, placebo-controlled trial of 21 weeks' duration was conducted at 4 university centers. Participants were 73 obese (body mass index >or= 30 kg/m(2)) outpatients with BED (DSM-IV criteria), both genders, and aged from 18 to 60 years. After a 2- to 5-week run-in period, selected participants were treated with group CBT (19 sessions) and topiramate (target daily dose, 200 mg) or placebo (September 2003-April 2005). The main outcome measure was weight change, and secondary outcome measures were binge frequencies, binge remission, Binge Eating Scale (BES) scores, and Beck Depression Inventory (BDI) scores. RESULTS: Repeated-measures random regression analysis revealed a greater rate of weight reduction associated with topiramate over the course of treatment (p < .001), with patients taking topiramate attaining a clinically significant weight loss (-6.8 kg) compared to patients taking placebo (-0.9 kg). Although rates of reduction of binge frequencies, BES scores, and BDI scores did not differ between groups during treatment, a greater number of patients of the topiramate plus CBT group (31/37) attained binge remission compared to patients taking placebo (22/36) during the trial (p = .03). No difference between groups was found in completion rates; 1 patient (topiramate group) withdrew for adverse effect. Paresthesia and taste perversion were more frequent with topiramate, and insomnia was more frequent with placebo (p < .05). CONCLUSIONS: Topiramate added to CBT improved the efficacy of the later, increasing binge remission and weight loss in the short run. Topiramate was well tolerated, as shown by few adverse events during treatment. CLINICAL TRIALS REGISTRATION: ClinicalTrials.gov identifier NCT00307619.

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Eur Eat Disord Rev. 2007 Sep 18 [Epub ahead of print]
Getting better byte by byte: a pilot randomised controlled trial of email therapy for bulimia nervosa and binge eating disorder.
Robinson P, Serfaty M.
Russell Unit, Barnet Enfield and Haringey Mental Health Trust, UK.

One hundred and ten people in an university population responded to emailed eating disorder questionnaires. Ninty-seven fulfilling criteria for eating disorders (bulimia nervosa (BN), binge eating disorder (BED), EDNOS) were randomised to therapist administered email bulimia therapy (eBT), unsupported Self directed writing (SDW) or Waiting list control (WLC). Measures were repeated at 3 months. Diagnosis, Beck depression inventory (BDI) and Bulimia investigatory test (BITE) scores were recorded. Follow-up rate was 63% and results must be interpreted cautiously. However significantly fewer participants who had received eBT or SDW fulfilled criteria for eating disorders at follow up compared to WLC. There was no significant difference between eBT and SDW in the analysis of variance (ANOVA), although in separate analyses, eBT was significantly superior to WLC (p < 0.02) and the difference for SDW approached significance (p = 0.06). BDI and BITE scores showed no significant change. For eBT participants there was a significant positive correlation between words written and improvement in BITE severity score. BN, BED and EDNOS can be treated via email. Copyright (c) 2007 John Wiley & Sons, Ltd and Eating Disorders Association.

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Expert Opin Pharmacother. 2007 Sep;8(13):2029-44.
Eating disorders: an overview of treatment responses and the potential impact of vulnerability genes and endophenotypes.
Ramoz N, Versini A, Gorwood P.
1INSERM U675, Université Paris 7, IFR02, Faculté de Médecine Xavier Bichat, Paris, France.

Anorexia nervosa (AN), bulimia nervosa (BN) and binge-eating disorder (BED) are the three main eating disorders. Antidepressants, antipsychotics, anticonvulsants, prokinetic agents, opiate antagonists, appetite suppressants, tetrahydrocannabinol, cyproheptadine, zinc and ondansetron have been tested, and are frequently associated with psychological treatment. Selective serotonin reuptake inhibitors have a proven efficacy in BN and binge eating disorder. Other treatments, such as atypical antipsychotics in AN, anticonvulsants in BN and BED, and naltrexone and ondansetron in BN, may be promising, but lack the appropriate trials. The development of genetic researches in eating disorders may help the clinician to choose the most appropriate treatment in forthcoming years, using genetic polymorphisms of vulnerability genes, those linked to endophenotypes, or genes implicated in the metabolism of the drug treatment.

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Eur Eat Disord Rev. 2007 Sep;15(5):357-65.
Which elements in the treatment of eating disorders are necessary 'ingredients' in the recovery process?—A comparison between the patient's and therapist's view.
Vanderlinden J, Buis H, Pieters G, Probst M.
University Center St-Jozef, Kortenberg, Belgium. johan.vanderlinden@uc-kortenberg.be

BACKGROUND: Little is known about which therapeutic 'ingredients' in the treatment of eating disorders (anorexia nervosa (AN), bulimia nervosa (BN) and binge eating disorder (BED)) are needed for recovery. Remarkably, most studies on this topic have neglected the patient's view. METHOD: In this study, a large sample of eating disorder patients (n = 132) was invited to evaluate which elements in the treatment they consider to be helpful and effective in their recovery process. These results were compared to the view of 49 eating disorder experts. RESULTS: Following the patient's view, 'improving self-esteem', 'improving body experience' and 'learning problem solving skills', were considered as core elements in their treatment. No major differences were found between the different patient samples when comparing the patient's and therapist's view. DISCUSSION: The findings suggest that therapists and patients share more or less the same view about the basic and effective elements in the treatment. 2006 John Wiley & Sons, Ltd and Eating Disorders Association

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Eur Eat Disord Rev. 2007 Aug 28; [Epub ahead of print]
Symptom severity and treatment course of bulimic patients with and without a borderline personality disorder.
Zeeck A, Birindelli E, Sandholz A, Joos A, Herzog T, Hartmann A.
Department of Psychosomatic Medicine and Psychotherapy, University of Freiburg, Germany.

There are contradictory results concerning the frequency of borderline personality disorder (BPD) in bulimic patients and its impact on eating pathology and treatment outcome. We evaluated 240 patients with bulimia nervosa using EDI-2, SIAB and SCL-90-R. Only a minority of patients had a BPD (13.8%). There were no differences in binging or purging behaviour between patients with and without BPD, but borderline patients had significantly more feelings of ineffectiveness and more disturbances in interoceptive awareness. Bulimic patients with BPD showed significantly more general psychopathology. Although, BPD patients started with higher levels of pathology, there were similar reductions of symptoms over the course of treatment in both groups. Psychotherapy in bulimic patients with a BPD has to focus not only on eating pathology but also on aspects that are caused by the severe personality disturbance. Copyright (c) 2007 John Wiley & Sons, Ltd and Eating Disorders Association.

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Aust Fam Physician. 2007 Aug;36(8):614-9.
Eating disorders in adolescents.
Gonzalez A, Kohn MR, Clarke SD.
Centre for Research into Adolescents' Health (CRASH), Department of Adoelscent Medicine, Westmead Hospital, New South Wales, Australia.

BACKGROUND: The overall prevalence of eating disorders among children and adolescents is rising - the younger age group are more likely to present with anorexia nervosa (AN), while the older adolescent can present with either AN or bulimia nervosa (BN). However, eating disorders exist as part of a spectrum and general practitioners will encounter many adolescents that have an eating disorder that do not yet fulfil diagnostic criteria for either AN or BN. OBJECTIVE: This article aims to provide an overview of assessment and principles of management of eating disorders in the adolescent patient. DISCUSSION: General practitioners are key in recognising and offering early intervention in cases of incipient eating disorders or problem dieting behaviour. The physical findings of AN are those of protein calorie malnutrition, while in BN, they reflect chronic purging. Failure of outpatient management requires hospitalisation for nutritional rehabilitation with close monitoring of fluid and electrolyte status to prevent the development of refeeding syndrome. Family involvement is vital, particularly in the younger patient, with ongoing family therapy offering the best outcomes.

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Int J Eat Disord. 2007 Jul 2; [Epub ahead of print]
Cue exposure in the treatment of resistant adolescent bulimia nervosa.
Martinez-Mallén E, Castro-Fornieles J, Lázaro L, Moreno E, Morer A, Font E, Julien J, Vila M, Toro J.
Department of Child and Adolescent Psychiatry and Psychology, Institute Clinic of Neurosciences, Hospital Clínic Universitari of Barcelona, Barcelona, Spain.

OBJECTIVE:: A percentage of bulimic patients do not greatly improve with the usual treatment. Therefore, the objective was to further evaluate cue exposure (CE), in order to attain better results in clinical settings. METHOD:: Twenty-two adolescent patients who fulfilled DSM-IV diagnostic criteria for bulimia nervosa (mean age 16.7, SD 1.5) and who were resistant to the usual treatment followed a program of 12 CE sessions. Clinical characteristics were evaluated and different psychopathological scales were administered at the beginning and the end of the CE program and at 6 month follow-up. Subjective anxiety and physiological parameters were recorded during the sessions. RESULTS:: A significant decrease was observed in subjective anxiety (p = .023), heart rate (p < .001), and blood pressure (p = .001) during the first session. A decrease in these parameters was also recorded between the first and the last session. The number of binges per week (p = .005) and the mean score for the psychopathological scales decreased significantly from the beginning of the treatment, and were significantly lower at the end of the CE program and at follow-up. Purging behaviors per week only decreased significantly after the end of the CE session during the follow-up (p = .04). CONCLUSION:: Anxiety, bingeing, purging, and psychopathological scales improve with a CE program in resistant bulimia nervosa. (c) 2007 by Wiley Periodicals, Inc. Int J Eat Disord 2007.

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Evid Rep Technol Assess (Full Rep). 2006 Apr;(135):1-166.
Management of eating disorders.
Berkman ND, Bulik CM, Brownley KA, Lohr KN, Sedway JA, Rooks A, Gartlehner G.

OBJECTIVES: The RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center (RTI-UNC EPC) systematically reviewed evidence on efficacy of treatment for anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED), harms associated with treatments, factors associated with the treatment efficacy and with outcomes of these conditions, and whether treatment and outcomes for these conditions differ by sociodemographic characteristics. DATA SOURCES: We searched MEDLINE(R), the Cumulative Index to Nursing and Applied Health (CINAHL), PSYCHINFO, the Educational Resources Information Center (ERIC), the National Agricultural Library (AGRICOLA), and Cochrane Collaboration libraries. REVIEW METHODS: We reviewed each study against a priori inclusion/exclusion criteria. For included articles, a primary reviewer abstracted data directly into evidence tables; a second senior reviewer confirmed accuracy. We included studies published from 1980 to September 2005, in all languages. Studies had to involve populations diagnosed primarily with AN, BN, or BED and report on eating, psychiatric or psychological, or biomarker outcomes. RESULTS: We report on 30 treatment studies for AN, 47 for BN, 25 for BED, and 34 outcome studies for AN, 13 for BN, 7 addressing both AN and BN, and 3 for BED. The AN literature on medications was sparse and inconclusive. Some forms of family therapy are efficacious in treating adolescents. Cognitive behavioral therapy (CBT) may reduce relapse risk for adults after weight restoration. For BN, fluoxetine (60 mg/day) reduces core bulimic symptoms (binge eating and purging) and associated psychological features in the short term. Individual or group CBT decreases core behavioral symptoms and psychological features in both the short and long term. How best to treat individuals who do not respond to CBT or fluoxetine remains unknown. In BED, individual or group CBT reduces binge eating and improves abstinence rates for up to 4 months after treatment; however, CBT is not associated with weight loss. Medications may play a role in treating BED patients. Further research addressing how best to achieve both abstinence from binge eating and weight loss in overweight patients is needed. Higher levels of depression and compulsivity were associated with poorer outcomes in AN; higher mortality was associated with concurrent alcohol and substance use disorders. Only depression was consistently associated with poorer outcomes in BN; BN was not associated with an increased risk of death. Because of sparse data, we could reach no conclusions concerning BED outcomes. No or only weak evidence addresses treatment or outcomes difference for these disorders. CONCLUSIONS: The literature regarding treatment efficacy and outcomes for AN, BN, and BED is of highly variable quality. In future studies, researchers must attend to issues of statistical power, research design, standardized outcome measures, and sophistication and appropriateness of statistical methodology.

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Presse Med. 2007 Apr 2; [Epub ahead of print]
[Nasogastric tube feeding in bulimia.]
[Article in French]
Rigaud D, Brayer V, Biton-Jelic V, Pais V, Pennacchio H, Brun JM.
CHU Le Bocage, Dijon (21).

OBJECTIVE: Few effective treatments are available for severe forms of bulimia nervosa, which are accompanied by malnutrition, anxiety, and depressive mood. We previously showed in an open study that nasogastric tube feeding (TF) reduced binges and purging in patients with anorexia nervosa. METHODS: This prospective randomized trial compared bulimia patients in two treatment groups: one group received TF at home, together with psychotherapy, nutritional counseling and a support group while the control group received only psychotherapy, nutritional counseling, and a support group. Patients in the first group underwent TF for 8 weeks (exclusively for 10 days and associated with meals thereafter). Assessment was based on clinical examination, laboratory results, and a variety of questionnaires (our in-house instrument for measuring binge and vomiting episodes, eating disorder inventory, Beck's depression inventory and the Hamilton rating scale for anxiety), all performed at the onset of treatment and at 8days, 8 weeks (i.e., the end of TF), and 3 months after treatment began. RESULTS: Binges and vomiting disappeared faster and more frequently in TF patients than in the control group: 65% versus 29% (p<0.01). Three months later, these remained less frequent in the TF group than among controls (52% versus 33%, p=0.064). Nutritional status, depression, and anxiety improved more among the TF than control subjects (p<0.05). CONCLUSION: Tube feeding was effective in these patients with bulimia nervosa, reducing the number of binge and vomiting episodes and improving nutritional status and mood.

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Am J Psychiatry. 2007 Apr;164(4):591-8.
A randomized controlled trial of family therapy and cognitive behavior therapy guided self-care for adolescents with bulimia nervosa and related disorders.
Schmidt U, Lee S, Beecham J, Perkins S, Treasure J, Yi I, Winn S, Robinson P, Murphy R, Keville S, Johnson-Sabine E, Jenkins M, Frost S, Dodge L, Berelowitz M, Eisler I.
Section of Eating Disorders (PO59), Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AF, UK. u.schmidt@iop.kcl.ac.uk.

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.

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Psychother Psychosom Med Psychol. 2007 Mar-Apr;57(3-4):120-7.
[Body images of male patients with eating disorders.]
[Article in German]
Benninghoven D, Tadic V, Kunzendorf S, Jantschek G.
Klinik fur Psychosomatische Medizin und Psychotherapie, Universitatsklinikum Schleswig-Holstein, Campus Lubeck.

Ideals of male attractiveness have changed considerably. The ideal male body at present is characterized by low body fat and pronounced muscles. Similar to what has been found for women, these normative societal conceptions should influence the pathology of men with eating disorders. In the present study, men with and without eating disorders are compared regarding body satisfaction and body perception. Both questionnaire data and a computer assisted approach are applied. Men with bulimia nervosa wish to have a body with less fat whereas men with anorexia do not wish for a bigger body although they are seriously underweight. Men in all groups wish to have more muscles. Men with and without an eating disorder do not differ in this respect. The wish for less body fat and more muscles is associated with body dissatisfaction in men. Treatment of men with eating disorders should focus on men's body images similar to how it is conceptualized in treatments for women with eating disorders. Different from women, a body image focused approach for men should emphasize the meaning of muscularity.

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Compr Psychiatry. 2007 Mar-Apr;48(2):118-23. Epub 2006 Nov 7.
Body image in patients with eating disorders and their mothers, and the role of family functioning.
Benninghoven D, Tetsch N, Kunzendorf S, Jantschek G.
University of Schleswig-Holstein, Campus Luebeck, Clinic for Psychosomatic Medicine, 23538 Luebeck, Germany. benningh@medinf.mu-luebeck.de

OBJECTIVE: Little is known about body images of mothers of patients with eating disorders. In this study we investigated body image in patients with eating disorders and in their mothers, and the relationship of their body images with family functioning. METHODS: A computer program was used that allows modeling perceived and desired body images of patients and their mothers. Patients and mothers estimated their own body images and mothers estimated the images they have of their daughters with eating disorders. The selected images were compared to anthropometric data and family functioning according to the Family Assessment Measure. Data from 29 patients with the diagnosis of anorexia nervosa and 20 patients with bulimia nervosa are presented. RESULTS: Both in patients with anorexia and in patients with bulimia, aspects of family functioning were associated with mothers' and daughters' perceptual body size distortion and body dissatisfaction. Mothers' perception of family functioning predicted daughters' perceptual body size distortion and body dissatisfaction in the total sample of 49 patients. CONCLUSION: Body images of mothers and mothers' perceptions of family functioning may provide additional information for the treatment of patients with eating disorders.

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Prax Kinderpsychol Kinderpsychiatr. 2007;56(2):91-108.
[Dialectical behavior therapy for adolescents with anorexia and bulimia nervosa (DBT-AN/ BN)—a pilot study]
[Article in German]
Salbach H, Klinkowski N, Pfeiffer E, Lehmkuhl U, Korte A.
Charite-Universitatsmedizin Berlin, Campus Virchow-Klinikum, Klinik fur Psychiatrie, Psychosomatik und Psychotherapie des Kindes-und Jugendalters, Berlin. harriet.salbach@charite.de

Dialectical behavior therapy (DBT) was originally developed by Linehan (1993a, b) and modified by Miller et al. (1997) for suicidal adolescents with borderline personality features. Meanwhile, this therapy has also successfully applied in other adult clinical groups. The prior aim of the study is to evaluate the effectiveness of DBT for inpatient adolescents with anorexia and bulimia nervosa. In this pilot study (n=31) the efficacy of this treatment will be evaluated in a pre-post comparison. Different instruments will be used (SIAB, EDI-2, SCL-90-R, FBB). The first results are promising and we must hope that this new approach will improve the future treatment.

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Int J Eat Disord. 2007 Mar 16; [Epub ahead of print]
Bulimia nervosa treatment: A systematic review of randomized controlled trials.
Shapiro JR, Berkman ND, Brownley KA, Sedway JA, Lohr KN, Bulik CM.
Department of Psychiatry, University of North Carolina at Chapel Hill, North Carolina.

OBJECTIVE:: The RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center systematically reviewed evidence on efficacy of treatment for bulimia nervosa (BN), harms associatedwith treatments, factors associated with treatment efficacy, and differential outcome by sociodemographic characteristics. METHOD:: We searched six major databases published from 1980 to September 2005 in all languages against a priori inclusion/exclusion criteria; we focused on eating, psychiatric or psychological, and biomarker outcomes. RESULTS:: Forty-seven studies of medication only, behavioral interventions only, and medication plus behavioral interventions for adults or adolescents met our inclusion criteria. Fluoxetine (60 mg/day) decreases the core symptoms of binge eating and purging and associated psychological features in the short term. Cognitive behavioral therapy reduces core behavioral and psychological features in the short and long term. CONCLUSION:: Evidence for medication or behavioral treatment for BN is strong, for self-help is weak; for harms related to medication is strong but either weak or nonexistent for other interventions; and evidence for differential outcome by sociodemographic factors is nonexistent. Attention to sample size, standardization of outcome measures, attrition, and reporting of abstinence from target behaviors are required. Longer follow-up intervals, innovative treatments, and attention to sociodemographic factors would enhance the literature. (c) 2007 by Wiley Periodicals, Inc. Int J Eat Disord 2007.

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Int J Eat Disord. 2007 Mar 8;40(4):360-368 [Epub ahead of print]
The eating disorders medicine cabinet revisited: A clinician's guide to ipecac and laxatives.
Steffen KJ, Mitchell JE, Roerig JL, Lancaster KL.
Neuropsychiatric Research Institute, Fargo, North Dakota.

OBJECTIVE:: To describe the frequency of alternative medication use in bulimia nervosa (BN), and to review available nonprescription emetic (ipecac) and laxative products and their potential toxicities. METHOD:: Survey data were collected from 39 consecutive treatment-seeking patients with BN or subthreshold BN. Survey data of the available nonprescription and herbal products from local retail stores were also collected. Toxicology information was reviewed on these agents from MEDLINE and herbal textbooks. RESULTS:: Ipecac use occurred in 18% of the 39 patients. Laxatives had been used at some point to control weight or "get rid of food" by 67% of the patients. Of these, 31% had abused laxatives during the month prior to evaluation. In the product survey, 248 laxative-containing products were identified. CONCLUSION:: There are numerous laxative products readily available to patients, and many of them have significant associated toxicities. Patients with BN tend to endorse high rates of laxative use. While ipecac is used infrequently, it can have deleterious consequences. Patients with BN should be screened for use of both ipecac and laxatives and should be educated about the potential consequences associated with the misuse of these agents. (c) 2007 by Wiley Periodicals, Inc. Int J Eat Disord 2007.

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Prax Kinderpsychol Kinderpsychiatr. 2007;56(1):19-39.
[Intensive outpatient group treatment for adolescents with eating disorders]
[Article in German]
Michler P, Wolter-Flanz A, Linder M.
Klinik fur Kinder - und Jugendsychistrie Psychotherapie, Univeristatsstr, Regensburg. petra.michler@medbo.de

We present an intensive outpatient group treatment for girls with eating disorders (anorexia nervosa, bulimia nervosa, binge eating disorder) additionally to/instead of inpatient treatment or individually treatment by psychotherapists. The therapy concept is primarily behaviour therapy oriented, encouraging the self-management-abilities of the patients thereby learning self-determination and responsibility in dealing with their illness. The slow-open group concept provokes group cohesion, solidarity and support among girls, who share similar age-related development-stages and eating disorders. Other than cognitive behaviour therapy and the principles of self-management we use client-centered therapy, art-, dance- and nutritional therapy. For each patient an individual treatment plan is adapted depending on age, individual symptoms, problems and motivation. Each member of the group has to accept defined group rules during the group sessions. The group takes place twice a week and on one Saturday per month. The adolescents stay in their social environment. Transfer of therapeutic success into daily life therefore is immediate and longlasting. Duration of therapy is between four months and one year, longer only in complex cases. Parallel to the parent/patient cooperation a parental psycho-educative group is available.

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J Am Diet Assoc. 2006 Dec;106(12):2073-82.
Position of the American Dietetic Association: Nutrition intervention in the treatment of anorexia nervosa, bulimia nervosa, and other eating disorders.
American Dietetic Association.

It is the position of the American Dietetic Association that nutrition intervention, including nutritional counseling, by a registered dietitian (RD) is an essential component of the team treatment of patients with anorexia nervosa, bulimia nervosa, and other eating disorders during assessment and treatment across the continuum of care. Diagnostic criteria for eating disorders provide important guidelines for identification and treatment. However, it is thought that a continuum of disordered eating may exist that ranges from persistent dieting to subthreshold conditions and then to defined eating disorders, which include anorexia nervosa, bulimia nervosa, and binge eating disorder. Understanding the complexities of eating disorders, such as influencing factors, comorbid illness, medical and psychological complications, and boundary issues, is critical in the effective treatment of eating disorders. The nature of eating disorders requires a collaborative approach by an interdisciplinary team of psychological, nutritional, and medical specialists. The RD is an integral member of the treatment team and is uniquely qualified to provide medical nutrition therapy for the normalization of eating patterns and nutritional status. RDs provide nutritional counseling, recognize clinical signs related to eating disorders, and assist with medical monitoring while cognizant of psychotherapy and pharmacotherapy that are cornerstones of eating disorder treatment. Specialized resources are available for RDs to advance their level of expertise in the field of eating disorders. Further efforts with evidenced-based research must continue for improved treatment outcomes related to eating disorders along with identification of effective primary and secondary interventions.

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Prescrire Int. 2006 Dec;15(86):221.
Fluoxetine. Bulimia nervosa: don't use.
[No authors listed]

In practice, in patients seeking treatment for bulimia nervosa, fluoxetine has been shown to provide only transient efficacy, and patients are exposed to the drug's adverse effects. Cognitive and behavioural therapies are better treatment options.

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Bipolar Disord. 2006 Dec;8(6):686-95.
Comorbidity of eating disorders with bipolar disorder and treatment implications.
McElroy SL, Kotwal R, Keck PE Jr.
Psychopharmacology Research Program, Department of Psychiatry, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH 45267, USA. susan.mcelroy@uc.edu

OBJECTIVES: To review the scientific evidence examining the comorbidity among eating disorders and bipolar disorder (BD). METHODS: We reviewed all published English-language studies addressing the comorbidity of anorexia nervosa, bulimia, bulimia nervosa, and binge eating disorder in patients with BD and studies of comorbidity of BD in patients with eating disorders. In addition, we discuss the pharmacologic treatment implications from reviewed studies of agents used in BD and eating disorders. RESULTS: Community and clinical population studies of the lifetime prevalence rates of eating disorders in patients with BD, and of BD in patients with eating disorders, particularly when subthreshold and spectrum manifestations of these disorders are included, indicate high rates of comorbidity among these illnesses. CONCLUSIONS: Pharmacologic treatment approaches to patients with BD and a co-occurring eating disorder require examination of the possible adverse effects of the treatment of each syndrome on the other and attempts to manage both syndromes with agents that might be beneficial to both.

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Int J Eat Disord. 2006 Nov 1;40(2):95-101 [Epub ahead of print]
Treatment of bulimia nervosa: Where are we and where are we going?
Mitchell JE, Agras S, Wonderlich S.
Neuropsychiatric Research Institute, Fargo, North Dakota.

OBJECTIVE:: The purpose of this article is to review the extant treatment literature on bulimia nervosa and to offer suggestions for future research directions. METHOD:: The available treatment studies regarding both pharmacotherapy and psychotherapy are reviewed. RESULTS:: Both pharmacotherapy and psychotherapy appear to play a role in the treatment of bulimia nervosa; however, available data suggest that cognitive behavioral therapy remains the treatment of choice. CONCLUSION:: Additional work is clearly indicated regarding assisted and unassisted self-help. An enhanced form of CBT and the integrative cognitive-affective therapy both deserve further study. New approaches need to be piloted. More research is needed on treatment modeling. (c) 2006 by Wiley Periodicals, Inc. Int J Eat Disord 2006.

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Seishin Shinkeigaku Zasshi. 2006;108(7):736-41.
[Intensive psychiatric treatment system for bulimic patients by group therapy]
[Article in Japanese]
Suzuki K.

Concurrent bulimia nervosa/purging type and anorexia nervosa/binge-purging type including binge eating and purging behaviors are considered chronic types of eating disorders. The bulimic patients in this study had both these disorders. Psychiatric treatment for patients with eating disorders must focus on therapy of these bulimic patients, because bulimic patients are more prevalent in the psychiatric hospital and clinic, and they have more comorbid psychiatric disorders and more other addictive behaviors than other patients with eating disorders. We have devised an intensive psychiatric treatment system for bulimic patients by group therapy that consists of inpatient treatment, group therapy for parents and group rehabilitation. Inpatient treatment, called the Eating Disorders Education Program (EDEP), consists of group psychological education, group cognitive-behavioral therapy, group nutrition education, and group exercise. Group therapy for parents consists of psychological education and group meetings. Group rehabilitation consists of many group activities in a house named "Mimoza". Bulimic patients come to understand their own disorders and symptoms objectively and understand recovery from their disorders by the intensive treatment system. Bulimic patients generally recover very slowly from eating disorders, but our intensive psychiatric treatment system promotes rapid recovery.

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Int J Eat Disord. 2006 Nov;39(7):533-43.
Using imagery in cognitive-behavioral treatment for eating disorders: tackling the restrictive mode.
Mountford V, Waller G.
Eating Disorders Service, South West London and St. George's Mental Health NHS Trust, London, England. vicki.mountford@swlstg-tr.nhs.uk

A restrictive thinking style in the eating disorders, often referred to as "anorexic thinking," is often resistant to cognitive-behavioral interventions, even when apparent motivation is relatively high. It is argued that this difficulty is due in part to the ingrained nature of such thinking patterns, regardless of diagnosis. Those patterns reflect the ego-syntonic element of the eating disorders, and manifest as difficulty for the patient in identifying and challenging negative automatic thoughts and maladaptive core beliefs. There is a need to develop cognitive techniques that allow the individual to identify maladaptive cognitions as reflecting their restrictive schema mode, rather than being the only way of thinking and seeing the world. This study describes the use of imagery to enable patients to distinguish the restrictive thoughts from other cognitive perspectives. The restrictive "mode" is presented as part of the individual's personality structure (drawing on cognitive-behavioral models of personality), rather than being an external entity. This technique is designed to facilitate conventional cognitive-behavioral therapy, freeing the patient to challenge her cognitions and to engage in behavioral experiments. We present case material to illustrate this technique and its use in conjunction with other cognitive-behavioral techniques. Future directions and potential limitations are also discussed. (c) 2006 by Wiley Periodicals, Inc.
 

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