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Meta-Analysis
. 2009 Oct 7;2009(4):CD000562.
doi: 10.1002/14651858.CD000562.pub3.

Psychological treatments for bulimia nervosa and binging

Phillipa Pj Hay  1 , Josué Bacaltchuk, Sergio Stefano, Priyanka Kashyap
Affiliations
Meta-Analysis

Psychological treatments for bulimia nervosa and binging

Phillipa Pj Hay et al. Cochrane Database Syst Rev. .

Abstract

Background: A specific manual-based form of cognitive behavioural therapy (CBT) has been developed for the treatment of bulimia nervosa (CBT-BN) and other common related syndromes such as binge eating disorder. Other psychotherapies and modifications of CBT are also used.

Objectives: To evaluate the efficacy of CBT, CBT-BN and other psychotherapies in the treatment of adults with bulimia nervosa or related syndromes of recurrent binge eating.

Search strategy: Handsearch of The International Journal of Eating Disorders since first issue; database searches of MEDLINE, EXTRAMED, EMBASE, PsycInfo, CURRENT CONTENTS, LILACS, SCISEARCH, CENTRAL and the The Cochrane Collaboration Depression, Anxiety & Neurosis Controlled Trials Register; citation list searching and personal approaches to authors were used. Search date June 2007.

Selection criteria: Randomised controlled trials of psychotherapy for adults with bulimia nervosa, binge eating disorder and/or eating disorder not otherwise specified (EDNOS) of a bulimic type which applied a standardised outcome methodology and had less than 50% drop-out rate.

Data collection and analysis: Data were analysed using the Review Manager software program. Relative risks were calculated for binary outcome data. Standardised mean differences were calculated for continuous variable outcome data. A random effects model was applied.

Main results: 48 studies (n = 3054 participants) were included. The review supported the efficacy of CBT and particularly CBT-BN in the treatment of people with bulimia nervosa and also (but less strongly due to the small number of trials) related eating disorder syndromes.Other psychotherapies were also efficacious, particularly interpersonal psychotherapy in the longer-term. Self-help approaches that used highly structured CBT treatment manuals were promising. Exposure and Response Prevention did not enhance the efficacy of CBT.Psychotherapy alone is unlikely to reduce or change body weight in people with bulimia nervosa or similar eating disorders.

Authors' conclusions: There is a small body of evidence for the efficacy of CBT in bulimia nervosa and similar syndromes, but the quality of trials is very variable and sample sizes are often small. More and larger trials are needed, particularly for binge eating disorder and other EDNOS syndromes. There is a need to develop more efficacious therapies for those with both a weight and an eating disorder.

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Conflict of interest statement

None

Figures

1.1
1.1. Analysis
Comparison 1 CBT compared to a wait list or no treatment control group, Outcome 1 Number of people who did not show remission at end of treatment (100% binge free).
1.2
1.2. Analysis
Comparison 1 CBT compared to a wait list or no treatment control group, Outcome 2 Mean bulimic symptom scores at end of treatment (scores comparable between groups at start of trial).
1.3
1.3. Analysis
Comparison 1 CBT compared to a wait list or no treatment control group, Outcome 3 Number of people who dropped out due to adverse events.
1.4
1.4. Analysis
Comparison 1 CBT compared to a wait list or no treatment control group, Outcome 4 Number of people who dropped out due to any reason.
1.5
1.5. Analysis
Comparison 1 CBT compared to a wait list or no treatment control group, Outcome 5 Mean depression scores at end of treatment.
1.6
1.6. Analysis
Comparison 1 CBT compared to a wait list or no treatment control group, Outcome 6 Mean psychosocial/interpersonal functioning scores at end of treatment.
1.7
1.7. Analysis
Comparison 1 CBT compared to a wait list or no treatment control group, Outcome 7 Mean weight at end of treatment.
2.1
2.1. Analysis
Comparison 2 CBT compared to any other psychotherapy, Outcome 1 Number of people who did not show remission at end of treatment (100% binge free).
2.2
2.2. Analysis
Comparison 2 CBT compared to any other psychotherapy, Outcome 2 Mean bulimic symptom scores at end of treatment.
2.3
2.3. Analysis
Comparison 2 CBT compared to any other psychotherapy, Outcome 3 Number of people who dropped out due to adverse events.
2.4
2.4. Analysis
Comparison 2 CBT compared to any other psychotherapy, Outcome 4 Number of people who dropped out due to any reason.
2.5
2.5. Analysis
Comparison 2 CBT compared to any other psychotherapy, Outcome 5 Mean depression scores at end of treatment.
2.6
2.6. Analysis
Comparison 2 CBT compared to any other psychotherapy, Outcome 6 Mean end of trial scores of general psychiatric symptoms.
2.7
2.7. Analysis
Comparison 2 CBT compared to any other psychotherapy, Outcome 7 Mean differences in psychosocial/interpersonal functioning at end of treatment.
2.8
2.8. Analysis
Comparison 2 CBT compared to any other psychotherapy, Outcome 8 Mean weight at end of therapy (BMI where possible).
3.1
3.1. Analysis
Comparison 3 Guided self‐help CBT compared to pure self‐help CBT, Outcome 1 Number of people who did not show remission (100% binge free).
3.2
3.2. Analysis
Comparison 3 Guided self‐help CBT compared to pure self‐help CBT, Outcome 2 Average difference in bulimic symptoms at end of treatment.
3.3
3.3. Analysis
Comparison 3 Guided self‐help CBT compared to pure self‐help CBT, Outcome 3 Number of people who dropped out due to adverse events.
3.4
3.4. Analysis
Comparison 3 Guided self‐help CBT compared to pure self‐help CBT, Outcome 4 Number of people who dropped out due to any reason.
3.5
3.5. Analysis
Comparison 3 Guided self‐help CBT compared to pure self‐help CBT, Outcome 5 Average difference in depression at end of treatment.
3.6
3.6. Analysis
Comparison 3 Guided self‐help CBT compared to pure self‐help CBT, Outcome 6 Average difference in general psychiatric symptoms at end of treatment.
3.8
3.8. Analysis
Comparison 3 Guided self‐help CBT compared to pure self‐help CBT, Outcome 8 Mean weight at end of therapy (BMI where possible).
4.1
4.1. Analysis
Comparison 4 CBT versus CBT augmented by ERP, Outcome 1 Number of people who did not show remission (100% binge free).
4.2
4.2. Analysis
Comparison 4 CBT versus CBT augmented by ERP, Outcome 2 Mean scores on bulimic rating scale at end of treatment.
4.3
4.3. Analysis
Comparison 4 CBT versus CBT augmented by ERP, Outcome 3 Number of noncompleters due to any reason.
4.4
4.4. Analysis
Comparison 4 CBT versus CBT augmented by ERP, Outcome 4 Mean depression scores at end of treatment.
5.1
5.1. Analysis
Comparison 5 Any psychotherapy, NOT CBT, compared to a no treatment or waitlist control group, Outcome 1 Number of people who did not show remission (100% binge free).
5.2
5.2. Analysis
Comparison 5 Any psychotherapy, NOT CBT, compared to a no treatment or waitlist control group, Outcome 2 Mean scores on binge and/or purge frequency at end of treatment.
5.3
5.3. Analysis
Comparison 5 Any psychotherapy, NOT CBT, compared to a no treatment or waitlist control group, Outcome 3 Mean depression scores at end of treatment..
5.5
5.5. Analysis
Comparison 5 Any psychotherapy, NOT CBT, compared to a no treatment or waitlist control group, Outcome 5 Number of treatment non‐completers.
5.7
5.7. Analysis
Comparison 5 Any psychotherapy, NOT CBT, compared to a no treatment or waitlist control group, Outcome 7 Mean weight at end of therapy.
5.8
5.8. Analysis
Comparison 5 Any psychotherapy, NOT CBT, compared to a no treatment or waitlist control group, Outcome 8 EDE restraint scale scores at end of treatment.
6.1
6.1. Analysis
Comparison 6 Any psychotherapy, NOT CBT, compared to a control therapy (to date either nutritional management or B.T.), Outcome 1 Number of people who did not show remission (100% binge free).
6.2
6.2. Analysis
Comparison 6 Any psychotherapy, NOT CBT, compared to a control therapy (to date either nutritional management or B.T.), Outcome 2 Mean scores of bulimic symptoms at end of trial where scores were not different between groups at start.
6.4
6.4. Analysis
Comparison 6 Any psychotherapy, NOT CBT, compared to a control therapy (to date either nutritional management or B.T.), Outcome 4 Number of people who dropped out due to any reason.
6.5
6.5. Analysis
Comparison 6 Any psychotherapy, NOT CBT, compared to a control therapy (to date either nutritional management or B.T.), Outcome 5 Mean end of trial depression scores.
6.6
6.6. Analysis
Comparison 6 Any psychotherapy, NOT CBT, compared to a control therapy (to date either nutritional management or B.T.), Outcome 6 Mean end of trial scores on measures of social or interpersonal functioning.
6.7
6.7. Analysis
Comparison 6 Any psychotherapy, NOT CBT, compared to a control therapy (to date either nutritional management or B.T.), Outcome 7 Mean weight at end of therapy (Body Mass Index where possible).
7.1
7.1. Analysis
Comparison 7 CBT versus a component of CBT only ‐ most commonly a behavioural component (B.T.), Outcome 1 Number of people who did not remit (were not 100% binge free).
7.2
7.2. Analysis
Comparison 7 CBT versus a component of CBT only ‐ most commonly a behavioural component (B.T.), Outcome 2 Mean binge eating frequency at end of therapy.
7.3
7.3. Analysis
Comparison 7 CBT versus a component of CBT only ‐ most commonly a behavioural component (B.T.), Outcome 3 Mean depression scores at end of therapy.
7.4
7.4. Analysis
Comparison 7 CBT versus a component of CBT only ‐ most commonly a behavioural component (B.T.), Outcome 4 Number of subjects not completing therapy.
7.5
7.5. Analysis
Comparison 7 CBT versus a component of CBT only ‐ most commonly a behavioural component (B.T.), Outcome 5 Body mass index or weight at end of treatment.
7.6
7.6. Analysis
Comparison 7 CBT versus a component of CBT only ‐ most commonly a behavioural component (B.T.), Outcome 6 Mean general psychiatric symptom severity scores at end of treatment.
7.7
7.7. Analysis
Comparison 7 CBT versus a component of CBT only ‐ most commonly a behavioural component (B.T.), Outcome 7 Mean social adjustment scores at end of therapy.
7.8
7.8. Analysis
Comparison 7 CBT versus a component of CBT only ‐ most commonly a behavioural component (B.T.), Outcome 8 Mean bulimic symptom severity scores at end of treatment (eg Global EDE score).
8.1
8.1. Analysis
Comparison 8 Guided (non specialist) self‐help versus waiting‐list control group, Outcome 1 Number not abstinent from binge eating at end of treatment.
8.2
8.2. Analysis
Comparison 8 Guided (non specialist) self‐help versus waiting‐list control group, Outcome 2 Mean bulimic symptom scores (where possible binge eating weekly frequency) at end of treatment.
8.3
8.3. Analysis
Comparison 8 Guided (non specialist) self‐help versus waiting‐list control group, Outcome 3 Mean depression symptom scores on any depression rating scale at end of treatment.
8.4
8.4. Analysis
Comparison 8 Guided (non specialist) self‐help versus waiting‐list control group, Outcome 4 Mean interpersonal and social functioning on any appropriate rating scale at end of treatment..
8.5
8.5. Analysis
Comparison 8 Guided (non specialist) self‐help versus waiting‐list control group, Outcome 5 Mean general psychiatric symptom severity scores on any appropriate scale at end of treatment..
8.6
8.6. Analysis
Comparison 8 Guided (non specialist) self‐help versus waiting‐list control group, Outcome 6 Number of participants who withdrew because of an adverse event.
8.7
8.7. Analysis
Comparison 8 Guided (non specialist) self‐help versus waiting‐list control group, Outcome 7 Number of participants who withdrew from the study for any reason.
8.8
8.8. Analysis
Comparison 8 Guided (non specialist) self‐help versus waiting‐list control group, Outcome 8 Mean weight (BMI where possible) at end of treatment..
9.1
9.1. Analysis
Comparison 9 Guided self‐help versus specialist psychotherapy (CBT &/or IPT), Outcome 1 Non‐Abstinence rates for binge eating at end of therapy.
9.2
9.2. Analysis
Comparison 9 Guided self‐help versus specialist psychotherapy (CBT &/or IPT), Outcome 2 Mean end of trial bulimic symptoms (where possible binge eating frequency).
9.3
9.3. Analysis
Comparison 9 Guided self‐help versus specialist psychotherapy (CBT &/or IPT), Outcome 3 Number of people who dropped out for any reason.
9.4
9.4. Analysis
Comparison 9 Guided self‐help versus specialist psychotherapy (CBT &/or IPT), Outcome 4 Mean scores on depression rating scale at end of treatment.
9.5
9.5. Analysis
Comparison 9 Guided self‐help versus specialist psychotherapy (CBT &/or IPT), Outcome 5 Mean end of trial scores of psychosocial or interpersonal functioning.
9.6
9.6. Analysis
Comparison 9 Guided self‐help versus specialist psychotherapy (CBT &/or IPT), Outcome 6 Mean scores on EDE restraint scale.
9.7
9.7. Analysis
Comparison 9 Guided self‐help versus specialist psychotherapy (CBT &/or IPT), Outcome 7 6 month objective bulimic episodes.
9.8
9.8. Analysis
Comparison 9 Guided self‐help versus specialist psychotherapy (CBT &/or IPT), Outcome 8 6 month interpersonal functioning.
9.9
9.9. Analysis
Comparison 9 Guided self‐help versus specialist psychotherapy (CBT &/or IPT), Outcome 9 6 month depression scores.
10.1
10.1. Analysis
Comparison 10 Pure self help versus waitlist control group, Outcome 1 Mean end of trial interpersonal functioning.
10.2
10.2. Analysis
Comparison 10 Pure self help versus waitlist control group, Outcome 2 Mean end of trial depression scores.
10.3
10.3. Analysis
Comparison 10 Pure self help versus waitlist control group, Outcome 3 Number of dropouts due to any reason.
10.4
10.4. Analysis
Comparison 10 Pure self help versus waitlist control group, Outcome 4 Number of people who did not show remission.
10.5
10.5. Analysis
Comparison 10 Pure self help versus waitlist control group, Outcome 5 Mean difference in binge frequency.
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    1. Walsh BT, Wilson GT, Loeb KL, Devlin MJ, Pike KM, Roose SP, et al. Medication and psychotherapy in the treatment of bulimia nervosa. American Journal of Psychiatry 1997;154:523‐31. - PubMed
Wilfley 1993 {published data only}
    1. Wilfley DE, Agras WS, Telch CF, Rossiter EM, Schneider JA, Cole AG, et al. Group cognitive behavioural and group interpersonal psychotherapy for the nonpurging bulimic individual: a controlled comparison. Journal of Consulting and Clinical Psychology 1993;61:296‐305. - PubMed
Wilfley 2002 {published data only}
    1. Wilfley DE, Welch RR, Stein RI, Spurrell EB, Cohen LR, Saelens BE, et al. A randomized comparison of group cognitive‐behavioral therapy and group interpersonal psychotherapy for the treatment of overweight individuals with binge‐eating disorder. Archives of General Psychiatry 2002;59:713‐21. - PubMed
Wilson 1986 {published data only}
    1. Wilson GT, Rossiter E, Kleifield EI, Lindholm L. Cognitive‐behavioural treatment of bulimia nervosa: A controlled evaluation. Behavior Research & Therapy 1986;24:277‐88. - PubMed
Wilson 1991 {published data only}
    1. Wilson GT, Eldredge KL, Smith D, Niles B. Cognitive behavioral treatment with and without response prevention for bulimia. Behavior Research & Therapy 1991;29:575‐83. - PubMed
Wolf 1992 {published data only}
    1. Wolf EM, Crowther JH. An evaluation of behavioral and cognitive‐behavioral group interventions for the treatment of bulimia nervosa in women. International Journal of Eating Disorders 1992;11:3‐15.

References to studies excluded from this review

Agras 1992 {published data only}
    1. Agras WS, Rossiter EM, Arnow B, Schneider JA, Telch CF, Raeburn SD, et al. Pharmacologic and cognitive‐behavioural treatment for bulimia nervosa: A controlled comparison. American Journal of Psychiatry 1992;149:82‐7. - PubMed
Agras 1995 {published data only}
    1. Agras WS, Telch CF, Arnow B, Eldredge K. Detzer MJ, HendersonJ, et al. Does interpersonal therapy help patients with binge eating disorder who fail to respond to cognitive‐behavioral therapy?. Journal of Consulting & Clinical Psychology 1995;63:356‐60. - PubMed
Bara‐Carril 2004 {published data only}
    1. Bara‐Carril N, Williams CJ, Pombo‐Carril MG, Reid Y, Murray K, Aubin S, Harkin PJR, Treasure J, Schmidt U. A preliminary investigation into the feasibility and efficacy of a CD‐ROM‐based cognitive‐behavioral self‐help intervention for bulimia nervosa. International Journal of Eating Disorders 2004;35:538‐548. - PubMed
Bergh 2002 {published data only}
    1. Bergh C, Brodin U, Lindberg G, Sodersten P. Randomized controlled trial of a treatment for anorexia and bulimia nervosa. Proceedings of the National Academy of Sciences of the USA 2002;99(14):9486‐91. - PMC - PubMed
Berry 1989 {published data only}
    1. Berry DM, Abramowitz SI. Educative/supportive groups and subliminal psychodynamic activation for bulimic college women. International Journal of Eating Disorders 1989;8:75‐85.
Beumont 1997 {published data only}
    1. Beumont PJ, Russall JD, Touyz SW, Buckley C, Lowinger K, Talbot P, et al. Intensive nutritional counselling in bulimia nervosa: a role for supplementation with fluoxetine?. Australian & New Zealand Journal of Psychiatry 1997;31:514‐24. - PubMed
Blouin 1994 {published data only}
    1. Blouin JH, Carter JC, Blouin AG, Tener L, Schnare‐Hayes K, Zuro C, et al. Prognostic indicators in bulimia nervosa treated with cognitive‐behavioral group therapy. International Journal of Eating Disorders 1994;15:113‐23. - PubMed
Blouin 1995 {published data only}
    1. Blouin J, Schnarre K, Carter J, Blouin A, Tener L, Zuro C, et al. Factors affecting dropout rate from cognitive‐behavioral group treatment for bulimia nervosa. International Journal of Eating Disorders 1995;17:323‐9. - PubMed
Brambilla 1995 {published data only}
    1. Brambilla F, Draisci A, Peirone A, Brunetta M. Combined cognitive‐behavioural, psychopharmacological and nutritional therapy in bulimia nervosa. Neuropsychobiology 1995;32:68‐71. - PubMed
Burton 2007 {published data only}
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Chen 2003 {published data only}
    1. Chen E, Touyz SW, Beumont PJV, Fairburn CG, Griffiths R, Butow P, Russell J, Schotte DE, Gertler R, Basten C. Comparison of group and individual cognitive behavioral therapy for patients with bulimia nervosa. International Journal of Eating Disorders 2003;33:241‐254. - PubMed
Crosby 1998 {published data only}
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Davis 1990 {published data only}
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Davis 1992 {published data only}
    1. Davis R, Olmsted MP, Rockert W. Brief group psychoeducation for bulimia nervosa II. International Journal of Eating Disorders 1992;11:205‐11. - PubMed
Davis 1999 {published data only}
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Devlin 2000 {published data only}
    1. Devlin MJ, Goldfein JA, Carino JS, Wolk SL. Open treatment of overweight binge eaters with phentermine and fluoxetine as an adjunct to cognitive‐behavioral therapy. International Journal of Eating Disorders 2000;28(3):325‐32. - PubMed
Devlin 2005 {published data only}
    1. Devlin MJ, Goldfein JA, Petkova E, Jiang H, Raizman PS, Wolk S, Mayer L, Carino J, Bellace D, Kamenetz C, Dobrow I, Walsh BT. Cognitive behavioral therapy and fluoxetine as adjuncts to group behavioral therapy for binge eating disorder. Obesity Research 2005;13(6):1077‐1088. - PubMed
Dixon 1984 {published data only}
    1. Dixon KN, Kiecolt‐Glaser J. Group therapy for bulimia. Hillside Journal of Clinical Psychiatry 1984;6:156‐70. - PubMed
Dunn 2006 {published data only}
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Eldredge 1997 {published data only}
    1. Eldredge KL, Agras WS, Arnow B, Telch CF, Bell S, Castonguay L, et al. The effects of extending cognitive‐behavioral therapy for binge eating disorder among initial treatment nonresponders. International Journal of Eating Disorders 1997;21:347‐52. - PubMed
Fahy 1993 {published data only}
    1. Fahy TA, Eisler I, Russell GF. A placebo‐controlled trial of d‐fenfluramine in bulimia nervosa. British Journal of Psychiatry 1993;162:597‐603. - PubMed
Fairburn 1992 {published data only}
    1. Fairburn CG. The current status of the psychological treatments for bulimia nervosa. Journal of Psychosomatic Research 1988;32(6):635‐45. [ISSN: 0022‐3999] - PubMed
    1. Fairburn CG. The uncertain status of the cognitive approach to bulimia nervosa. In: Pirke KM, Vandereycken W, Ploog D editor(s). The psychobiology of bulimia nervosa. Berlin: Springer‐Verlag, 1988.
    1. Fairburn CG, Agras WS, Wilson GT. The research on the treatment of bulimia nervosa: Practical and theoretical implications. Biology of feast and famine. Academic Press, 1992:317‐40.
Fernandez‐Aranda2000 {published data only}
    1. Fernandez‐Aranda F. Psychoeducational group therapy in bulimia nervosa [Terapia grupal psicoeducativa en bulimia nerviosa]. Revista Psicologia Contemporanea Ano 7 2000;7(1):16‐25.
Fichter 1991 {published data only}
    1. Fichter MM, Leibl K, Rief W, Brunner E, Schmidt‐Auberger S, Engel RR. Fluoxetine vs placebo: A double blind study with bulimic inpatients undergoing intensive psychotherapy. Pharmacopsychiatry 1991;24(1):1‐7. - PubMed
Fossati 2004 {published data only}
    1. Fossati M, Amati F, Painot D, Reiner M, Haenni C, Golay A. Cognitive behavioral therapy with simultaneous nutritional and physical activity education in obese patients with binge eating disorder. Eating and weight Disorders 2004;9:134‐138. - PubMed
Frommer 1987 {published data only}
    1. Frommer MS, Ames JR, Gibson JW, Davis WN. Patterns of symptom change in the short‐term treatment of bulimia. International Journal of Eating Disorders 1987;6:469‐76.
Garner 1987 {published data only}
    1. Garner DM, Fairburn CG, Davis R. Cognitive‐behavioural treatment of bulimia nervosa A critical appraisal. Behaviour Modification 1987;11:398‐431. - PubMed
Garvin 1997 {published data only}
    1. Garvin V, Striegel‐Moore R, Wells AM. Participant reactions of a cognitive‐behavioural guided self‐help program for binge eating: Developing criteria for program evaluation. Journal of Psychosomatic Research 1998;44:407‐12. - PubMed
Ghaderi 2006 {published data only}
    1. Ghaderi A. Does individualization matter? A randomised trial of standardized (focused) versus individualized (broad) cognitive behavior therapy for bulimia nervosa. Behaviour Research and Therapy 2006;44:273‐288. - PubMed
Goldbloom 1997 {published data only}
    1. Goldbloom DS, Olmsted M, Davis R, Clewes J, Heinmaa M, Rockert W, et al. A randomized controlled trial of fluoxetine and cognitive behavioral therapy for bulimia nervosa. Behavior Research & Therapy 1997;35:803‐11. - PubMed
Goodrick 1998 {published data only}
    1. Goodrick GK, Pendleton VR, Kimball KT, Poston WS, Reeves RS, Foreyt JP. Binge eating severity, self‐concept, dieting self‐efficacy and social support during treatment of binge eating disorder. International Journal of Eating Disorders 1999;26:295‐300. - PubMed
    1. Goodrick GK, Poston WSC, Kimball KT, Reeves RS, Foreyt JP. Non‐dieting vs. dieting treatment for overweight binge‐eating women. Journal of Consulting & Clinical Psychology 1998;66(2):363‐8. - PubMed
Gray 1990 {published data only}
    1. Gray JJ, Hoage CM. Bulimia nervosa: Group behavior therapy with exposure plus response prevention. Psychlogical Reports 1990;66:667‐74. - PubMed
Griffiths 1989 {published data only}
    1. Griffiths RA. Hypnobehavioral treatment for bulimia nervosa: Preliminary findings. Australian Journal of Clinical & Experimental Hypnosis 1989;17:79‐87.
    1. Griffiths RA. Two‐year follow‐up findings of hypnobehavioural treatment for bulimia nervosa. Australian Journal of Clinical & Experimental Hypnosis 1995;23:135‐44.
Griffiths 1990 {published data only}
    1. Griffiths RA. Characteristics of dropouts and completers from hypnobehavioral treatment for bulimia nervosa. International Journal of Eating Disorders 1990;9:217‐9.
Griffiths 1996 {published data only}
    1. Griffiths RA, Channon‐Little L. Psychological treatments and bulimia nervosa: An update. Australian Psychologist 1996;31:79‐96.
Grilo 2005a {published data only}
    1. Grilo CM, Masheb RM. A randomized controlled comparison of guided self help cognitive behavioral therapy and behavioral weight loss for binge eating disorder. Behaviour Research and Therapy 2005;43:1509‐1525. - PubMed
Grilo 2005b {published data only}
    1. Grilo CM, Masheb RM, Wilson GT. Efficacy of cognitive behavioral therapy and fluoxetine for the treatment of binge eating disorder: a randomised double‐blind placebo‐controlled comparison. Biological Psychiatry 2005;57:301‐309. - PubMed
Herzog 1991a {published data only}
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Hilbert 2004 {published data only}
    1. Hilbert A, Tuschen‐Caffier B. Body image interventions in cognitive‐behavioural therapy of binge‐eating disorder: a component analysis. Behaviour Research and Therapy 2004;42:1325‐1339. - PubMed
Huon 1985 {published data only}
    1. Huon GF. An initial validation of a self‐help program for bulimia. International Journal of Eating Disorders 1985;4:573‐88.
Jager 1996 {published data only}
    1. Jager B, Liedtke JB, Kunsbeck HW, Lempa W, Kersting A, Seide L. Psychotherapy and bulimia nervosa: evaluation and longterm follow‐up of two conflict orientated treatment conditions. Acta Psychiatrica Scandinavica 1996;93:268‐78. - PubMed
    1. Jager B, Liedtke R, Lamprecht F, Freyberger H. Social and health adjustment of bulimic women 7‐9 years following therapy. Acta Psychiatrica Scandinavica 2004;110:138‐145. - PubMed
Jager 1997 {published data only}
    1. Jager B, Wietersheim J. Psychoanalytically‐based treatment of bulimia nervosa [Die tiefenpsychologisch fundierte Behandlung der Bulimia nervosa]. Psychotherapie, Psychosomatik, Medizinische Psychologie 1997;47(9‐10):322‐31. - PubMed
Johnson 1984 {published data only}
    1. Johnson WG, Schlundt DG, Kelley ML, Ruggiero L. Exposure with response prevention and energy regulation in the treatment of bulimia. International Journal of Eating Disorders 1984;3:37‐46.
Johnson 1993 {published data only}
    1. Johnson Cl, Sansone RA. Integrating the twelve‐step approach with traditional psychotherapy for the treatment of eating disorders. International Journal of Eating Disorders 1993;14:121‐34. - PubMed
Keefe 1983 {published data only}
    1. Keefe PH, Wyshogrod D, Weinberger E, Agras WS. Binge eating and outcome of behavioural treatment of obesity: A preliminary report. Behaviour Research & Therapy 1984;22:319‐21. - PubMed
Kong 2005 {published data only}
    1. Kong S. Day treatment programme for patients with eating disorders: randomized controlled trial. Journal of Advanced Nursing 2005;51(1):5‐14. - PubMed
Le Grange 2002 {published data only}
    1. Grange D, Gorin A, Dymek M, Stone A. Does ecological momentary assessment improve cognitive behavioral therapy for binge eating disorder? A pilot study. European Eating Disorders Review 2002;10:361‐328.
Leitenberg 1994 {published data only}
    1. Leitenberg H, Rosen JC, Wolf J, Vara LS, Detzer MJ, Srebnik D. Comparison of cognitive‐behaviour therapy and desipramine in the treatment of bulimia nervosa. Behavior Research & Therapy 1994;32:37‐45. - PubMed
Levine 1996 {published data only}
    1. Levine MD, Marcus MD, Moulton P. Exercise in the treatment of binge eating disorder. International Journal of Eating Disorders 1996;19:171‐7. - PubMed
Liedtke 1991 {published data only}
    1. Liedtke R, Jager B, Lempa W, Kunsbeck HW, Grone M, Freyberger H. Therapy outcome of two treatment models for bulimia nervosa. Psychotherapy & Psychosomatics 1991;56:56‐63. - PubMed
Loro 1981 {published data only}
    1. Loro AD, Orleans CS. Binge eating in obesity: Peliminary findings and guidelines for behavioral analysis and treatment. Addictive Behaviors 1981;6:155‐6. - PubMed
Mitchell 1990 {published data only}
    1. Keel PK, Mitchell JE, Davis TL, Crow SJ. Long‐term impact of treatment in women diagnosed with bulimia nervosa. International Journal of Eating Disorders 2002;31:151‐8. - PubMed
    1. Keel PK, Mitchell JE, Miller KB, Davis TL, Crow SJ. Long‐term outcome of bulimia nervosa. Archives of General Psychiatry 1999;56:63‐9. - PubMed
    1. Mitchell J, Fletcher L, Pyle R, Eckert E, Hatsukami D, Pomeroy C. The impact on meal patterns in patients with bulimia nervosa. International Journal of Eating Disorders 1989;8:167‐72.
    1. Mitchell JE, Pyle RL, Eckert ED, Hatsukami D, Pomeroy C, Zimmerman R. A comparison study of antidepressants and structured intensive group psychotherapy in the treatment of bulimia nervosa. Archives of General Psychiatry 1990;47:149‐57. - PubMed
    1. Mitchell JE, Pyle RL, Eckert ED, Pomeroy C, Hatsukami C, Zimmerman R. Antidepressants vs group therapy in the treatment of bulimia. Psychopharmacology Bulletin 1987;23:41‐4. - PubMed
Mitchell 1991 {published data only}
    1. Mitchell JE. A review of the controlled trials of psychotherapy for bulimia nervosa. Journal of Psychosomatic Research 1991;35:23‐31. - PubMed
Mitchell 2001 {published data only}
    1. Mitchell JE, Fletcher L, Hanson K, et al. The relative efficacy of fluoxetine and manual‐based self‐help in the treatment of outpatients with bulimia nervosa. Journal of Clinical Psychopharmacology 2001;21:298‐304. - PubMed
Nevonen 2005 {published data only}
    1. Nevonen L, Broberg AG. A comparison of sequenced individual and group psychotherapy for eating disorder not otherwise specified. European Eating Disorders Review 2005;13:29‐37. - PubMed
Nevonen 2006 {published data only}
    1. Nevonen L, Broberg AG. A comparison of sequenced individual and group psychotherapy for patients with bulimia nervosa. International Journal of Eating Disorders 2006;39:117‐127. - PubMed
Olmsted 1991 {published data only}
    1. Olmsted MP, Davis R, Rockert W, Irvine MJ, Eagle M, Garner DM. Efficacy of a brief group psychoeducational intervention for bulimia nervosa. Behavior Research & Therapy 1991;29:71‐83. - PubMed
Pendleton 2002 {published data only}
    1. Pendleton VR, Goodrick GK, Carlos Poston WS, Reeves RS, Forey JP. Exercise augments the effects of cognitive‐behavioural therapy in the treatment of binge eating. International Journal of Eating Disorders 2002;31:171‐84. - PubMed
Reeves 2001 {published data only}
    1. Reeves RS, McPherson RS, Nichaman MZ, Harrist RB, Foreyt JP, Goodrick GK. Nutrient intake of obese female binge eaters. Journal of the American Dietetic Assosiation 2001;101:209‐215. - PubMed
Ricca 2001 {published data only}
    1. Ricca V, Mannucci E, Mezzani B, Moretti S, Bernardo M, Bertelli M, et al. Fluoxetine and fluvoxamine combined with individual cognitive‐behaviour therapy in binge eating disorder: A one‐year follow‐up study. Psychotherapy & Psychosomatics 2001;70:298‐306. - PubMed
Richards 2006 {published data only}
    1. Richards PS, Berrett ME, Hardman RK, Eggett DL. Comparative efficacy of spirituality, cognitive, and emotional support groups for treating eating disorder inpatients. Eating Disorders 2006;14:401‐415. - PubMed
Romano 2002 {published data only}
    1. Romano SJ, Halmi KA, Sarker NP, Koke SC, Lee JS. A placebo‐controlled study of fluoxetine in continued treatment of bulimia nervosa. American Journal of Psychiatry 2002;159:96‐102. - PubMed
Rossiter 1988 {published data only}
    1. Rossiter EM, Agras WS, Losch M, Telch CF. Dietary restraint of bulimic subjects following cognitive‐behavioral or pharmacological treatment. Behavior Research & Therapy 1988;26:495‐8. - PubMed
Russell 1987 {published data only}
    1. Russell GFM, Szmulker GI, Dare C, Eisler I. An evaluation of family therapy in anorexia nervosa and bulimia nervosa. Archives of General Psychiatry 1987;44:1947‐56. - PubMed
Russell 1992 {published data only}
    1. Fettes PA, Peters JM. A meta‐analysis of group treatments for bulimia nervosa. International Journal of Eating Disorders 1992;11:97‐110.
    1. Russell GF, Szmulker GI, Dare C, Eisler MA. An evaluation of family therapy in anorexia nervosa and bulimia nervosa. Archives of General Psychiatry 1987;44:1047‐56. - PubMed
Schmidt 1989 {published data only}
    1. Schmidt U, Marks IM. Exposure plus prevention of bingeing vs exposure plus prevention of vomiting in bulimia nervosa. Journal of Nervous & Mental Disease 1989;177:259‐66. - PubMed
Schmidt 2006 {published data only}
    1. Schmidt U, Landau S, Pombo‐Carril MG, Bara‐Carril N, Reid Y, Murray K, Treasure J, Katzman M. Does personalized feedback improve the outcome of cognitive‐behavioural guided self‐care in bulimia nervosa? A preliminary randomized controlled trial. British Journal of Clinical Psychology 2006;45:111‐121. - PubMed
Schmidt 2007 {published data only}
    1. Schmidt U, Lee S, Beecham J, Perkins S, Treasure J, Yi I, Winn S, Robinson P, Murphy R, Keville S, Johnson‐Sabine E. A randomized controlled trial of family therapy and cognitive behavior therapy guided self‐care for adolescents with bulimia nervosa and related disorders. American Journal of Psychiatry 2007;164:591‐8. - PubMed
Steel 2000 {published data only}
    1. Steel Z, Jones J, Adcock S, Clancy R, Bridgeford‐West L, Austin J. Why the high rate of dropout from individualized cognitive‐behavior therapy for bulimia nervosa. International Journal of Eating Disorders 2000;28(2):209‐14. - PubMed
Thiels 1998 {published data only}
    1. Thiels C, Schmidt U, Treasure J, Garthe R. Four‐year follow‐up of guided self‐change for bulimia nervosa. Eating and Weight Disorders 2003;8:212‐217. - PubMed
    1. Thiels C, Schmidt U, Treasure J, Garthe R, Troop N. Guided self‐change for bulimia nervosa incorporating use of a self‐care manual. American Journal of Psychiatry 1998;155:947‐53. - PubMed
    1. Thiels C, Schmidt U, Treasure J, Garthe R, Troop N. Wie wirksam und akzeptabel ist ein Selbstbeandlungsmanual mit begleitender Kurztherapie bei Bilimia nervosa?. Nervenatzt 1998;69:427‐36. - PubMed
    1. Thiels C, Schmidt U, Troop N, Treasure J, Garthe R. Compliance with a self‐care manual in guided self‐change for bulimia nervosa. European Eating Disorders Review 2001;9:115‐22.
Treasure 1999 {published data only}
    1. Treasure JL, Katzman M, Schmidt U. Engegement and outcome in the treatment of bulimia nervosa: first phase of a sequential design comparing motivation enhancement therapy and cognitive behavioural therapy. Behavior Research & Therapy 1999;37:405‐18. - PubMed
Ventura 1999 {published data only}
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Walsh 2000 {published data only}
    1. Agras WS, Crow SJ, Halmi KA, Mitchell JE, Wilson GT, Kraemer HC. Outcome predictors for cognitive behavior treatment of bulimia nervosa: Data from a multisite study. American Journal of Psychiatry 2000;157:1302‐8. - PubMed
    1. Walsh BT, Agras WS, Devlin MJ, et al. Fluoxetine for bulimia nervosa following poor response to psychotherapy. American Journal of Psychiatry 2000;157:1332‐4. - PubMed
Walsh 2004 {published data only}
    1. Walsh BT, Fairburn CG, Mickley D, Sysko R, Parides MK. Treatment of bulimia nervosa in a primary care setting. American Journal of Psychiatry 2004;161:556‐561. - PubMed
Wilson 1998 {published data only}
    1. Wilson GT, Fairburn CG. Treatments for eating disorders. In: Nathan PE, Gorman JM editor(s). A guide to treatments that work. Oxford: Oxford University Press, 1998:501‐530.
Wilson 2002 {published data only}
    1. Wilson GT, Fairburn CG. Treatments for eating disorders. In: Nathan PE, Gorman JM editor(s). A guide to treatments that work. 2nd Edition. New York, NY: Oxford University Press, 2002:559‐92.
Winzelberg 1998 {published data only}
    1. Winzelberg AJ, Taylor CB, Sharpe T, Eldredge KL, Dev P, Constantinou PS. Evaluation of a computer‐mediated eating disorder intervention program. International Journal of Eating Disorders 1998;24:339‐49. - PubMed
Wiseman 2002 {published data only}
    1. Wiseman CV, Sunday SR, Klapper F, Klein M, Halmi KA. Short‐term group CBT versus psycho‐education on an inpatient eating disorder unit. Eating Diorders 2002;10:313‐320. - PubMed
Woodside 1995 {published data only}
    1. Woodside DB, Shekter‐Wolfson L, Garfinkel PE, Olmsted MP, Kaplan AS, Maddocks SE. Family interactions in bulimia nervosa. International Journal of Eating Disorders 1995;17:105‐15. - PubMed
Yates 1984 {published data only}
    1. Yates AJ, Sambrailo F. Bulimia nervosa: a descriptive and therapeutic study. Behaviour Research and Therapy 1984;22(5):503‐17. - PubMed
Young 2001 {unpublished data only}
    1. Young M. A comparison study of the clinical effectiveness of guided self‐help for bulimia nervosa delivered either on an individual basis: does guided self‐help work in a group setting?. National Research Register 2001.
Zabinski 2004 {published data only}
    1. Zabinski MF, Wilfley DE, Calfas KJ, Winzelberg AJ, Taylor CB. An interactive psychoeducational intervention for women at risk of developing an eating disorder. Journal of consulting and Clinical Psychology 2004;72(5):914‐919. - PubMed

References to studies awaiting assessment

Castelnuovo 2004 {unpublished data only}
    1. Castelnuovo G, Baccetta M, Cesa G, Conti S, Gaggioli A/Mantovani F, Molinari E, Riva G. Virtual reality in the treatment and rehabilitation of eating disorders: A controlled study. 35th International Meeting of the Society for Psychotherapy Research. Rome: International Meeting of the Society for Psychotherapy Research, 2004 June 16 ‐ 19.
Dimcovic 2000 {unpublished data only}
    1. Dimcovic N. The comparison of two psychotherapeutic approaches for patients with bulimia. National Research Register. National Research Register 2000.
Kristeller 2003 {unpublished data only}
    1. Kristeller JL, Quillian‐Wolever RE. The use of mindfulness meditation techniques in treatment of binge eating disorder. International Conference on Eating Disorders. Denver CO: International Conference on Eating Disorders, 2003 (May 29‐31).
NIMH 2004 {unpublished data only}
    1. Anonymous. Cognitive therapy via CD‐rom for binge‐eating disorder. ClinicalTrials.gov 2004.
Robinson 2001 {unpublished data only}
    1. Robinson P. Using the internet as a vehicle for treatment of bulimia nervosa: a randomised control trial of cognitive behaviour therapy versus therapeutic writing. National Research Register 2001.
Schmidt 2004 {unpublished data only}
    1. Schmidt U. A preliminary randomised controlled trial of the efficacy of a CD‐ROM based cognitive‐behavioural self‐help intervention for bulimia nervosa. National Research Register 2004.
Scott Richards 2006 {published data only}
    1. Scott Richards P, Berrett ME, Hardman RK, Eggett DL. Comparative efficacy of spirituality, cognitive, and emotional support groups for treating eating disorder inpatients. Eating Disorders 2006;14(5):401‐5. - PubMed
Tasca 2005 {published data only}
    1. Abelian ME. Group Psychodynamic Interpersonal Psychotherapy: Summary of a treatment model and outcomes for depressive symptoms. In: Tasca GA, Mikail SF, Hewitt PL editor(s). Focus on psychotherapy research. Hapuppauge NY, USA: Nova Science Publishers, 2005:159‐88.
    1. Tasca GA, Ritchie K, Conrad G, Balfour L, Gayton J, Lybanon V, Bissada H. Attachment scales predict outcome in a randomized controlled trial of two group therapies for binge eating disorder: an aptitude by treatment interaction. Psychotherapy Research 2006;16(1):106‐21.

References to ongoing studies

Geller 2006 {unpublished data only}
    1. Geller J. The efficacy of readiness and motivation therapy in individuals with anorexia nervosa and bulimia nervosa. controlled‐trials.com 2000.
Robinson 2003 {unpublished data only}
    1. Robinson P, Serfaty M. Computers, e‐mail and therapy in eating disorders. European Eating Disorders Review 2003;11(3):201‐21.
Striegel‐Moore 2006 {unpublished data only}
    1. Striegel‐Moore RH. Binge eating self‐guided treatment (BEST). www.controlled‐trials.com 2006.
Tuschen‐Caffier 2004 {unpublished data only}
    1. Tuschen‐Caffier B, Schüssel C. How to improve body dissatisfaction; Mirror exposure compared to cognitive intervention. 32nd Congress of the British Association for Behavioural and Cognitive Psychotherapies (jointly with the European Association of Behavioural and Cognitive Therapies) 2004 (September 7 ‐ 11). Manchester, UK: British Association for Behavioural and Cognitive Psychotherapies, 2004.

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