BMJ 1994;308:686-689 (12 March)

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First step in managing bulimia nervosa: controlled trial of therapeutic manual

J Treasure, U Schmidt, N Troop, J Tiller, G Todd, M Keilen, E Dodge 

Eating Disorder Research Group, Institute of Psychiatry, London SE5 8AF Psychiatry Department, St Mary's Hospital, London W2 1NY University of Cologne, Cologne, Germany Correspondence to: Dr Treasure.

Abstract

Objective : To test the short term efficacy of a self directed treatment manual for bulimia nervosa.
Design : Randomised controlled trial of the manual against cognitive behavioural therapy and a waiting list.
Setting : Tertiary referral centre.
Subjects : 81 consecutive referrals presenting with bulimia nervosa or atypical bulimia nervosa.
Main outcome measures : Frequency of binge eating, vomiting, and other behaviours to control weight as well as abstinence from these behaviours.
Results : Cognitive behavioural treatment produced a significant reduction in the frequency of binge eating, vomiting, and other behaviours to control weight. The manual significantly reduced frequency of binge eating and weight control behaviours other than vomiting, and there was no change in the group on the waiting list. Full remission was achieved in five (24%) of the group assigned to cognitive behavioural treatment, nine (22%) of the group who used the manual, and two (11%) of the group on the waiting list.
Conclusions : A self directed treatment manual may be a useful first intervention in the treatment of bulimia nervosa.

Clinical implications

  • Clinical implications

  • Bulimia nervosa affects between 4% and 8% of women at some point in their lives

  • Psychological therapy is the treatment of choice but is labour intensive

  • This study found that use of a self directed treatment manual produced a smaller symptomatic improvement than cognitive behavioural therapy but was considerably better than remaining on a waiting list

  • Complete remission from binge eating, vomiting, and other weight control behaviours was achieved in 22% of women who used the manual


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