How effective are bulimia treatments?

How effective are bulimia treatments?

Results of a preliminary study to track the responses of young bulimic women to psychiatric treatment over an extended period are not encouraging, particularly for teenagers, according to a report presented last week at the annual meeting of the American Academy of Child and Adolescent Psychiatry in Washington, D.C.

After 18 months of treatment that included both psychotherapy and the use of antidepressant drugs, eight of 18 teenage bulimics were unimproved, reports David B. Herzog of Massachusetts General Hospital in Boston. The remaining 10 improved significantly for at least two months, he says, but by the end of the study, five had again developed symptoms of bulimia.

Bulimia is characterized by episodes of binge eating accompanied by feelings that the binges are abnormal and cannot be controlled. Depression and anguish, as well as induced vomiting, often follow a binge. Some bulimics employ extreme diets, constant exercise or laxatives to lose weight.

Several studies have used prior medical records and self-reports to estimate the long-term effectiveness of bulimia treatments among women in their 20s. Treatments and diagnostic criteria in the studies varied, as did estimates of symptom recurrence. Herzog and his co-workers used current psychiatric standards for bulimia and assigned each patient her own treatment plan, which included individual, group and family psychotherapy, antidepressant medication and nutritional counseling. Four follow-up interviews were conducted during the 18-month study.

In addition to the poor outcomes of the 18 bulimics between the ages of 15 and 19, the researchers found that four of 12 bulimic women in their 20s did not significantly improve for at least two months during the study. In contrast, notes Herzog, it is estimated that 22 percent of severely depressed, hospitalized patients do not improve after 18 months of psychiatric treatment.

About half of the bulimic women were also diagnosed as suffering from severe depression or milder mood disturbances. But there was no clear link between the two disorders, says Herzog. Significant improvement during the study, for example, was the same for bulimics with mood disorders and those without them.

A clearer picture will emerge from a larger sample, says Herzog. He and his co-workers recently received funding from the National Institute of Mental Health to conduct a similar study of 225 women with eating disorders, including 125 bulimics, over five years.