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Second-Line Treatments For Bulimia Found Ineffective

Currently available second-level treatment strategies for bulimia nervosa patients who do not respond to first-line cognitive behavioral therapy appear to be ineffective, and new models for such patients are necessary.

"In the case of bulimia nervosa, the research findings suggest that cognitive behavioral therapy (CBT) is the first level of treatment and that both antidepressant medication and interpersonal psychotherapy (IPT) may potentially be effective second-level treatments," say researchers at five American institutions.

They randomised 62 patients with bulimia nervosa who were unsuccessfully treated with CBT to either interpersonal psychotherapy or medication management. Of these, 37 completed treatment and 25 dropped out or were withdrawn.

Just 16 percent of those assigned to interpersonal psychotherapy abstained from bulimic behavior, and only 10 percent of those assigned to medication management abstained. No significant differences were found between medication and IPT in either the intent-to-treat or completer analysis.

"Dropout rates were high, and response rates were low among [bulimia nervosa] patients assigned to secondary treatments who failed to achieve remission with CBT," the researchers say. "Offering lengthy sequential treatments appears to have little value, and alternative models for therapy need to be tested."
Int J Eat Disord 32: 271-281, 2002. "A randomized secondary treatment study of women with bulimia nervosa who fail to respond to CBT"

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