Internal Medicine

0521779407-B02 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:52

Bulimia Nervosa 265

specific therapy

Pharmacological Treatment

■Antidepressants:

➣Bulimics without depression respond as well to antidepressant

treatment as do depressed bulimics

➣All antidepressant agents have proven effective to some extent

➣On average:

Binge eating and purging decline about 80%

35–50% of patients become symptom-free for some period of

time

➣Relapse to binging often occurs when medication is withdrawn,

and occasionally even when medication is maintained

➣Long-term efficacy with current medications has not been estab-

lished

Cognitive-Behavioral Therapy (CBT)

■Goals:

➣Enhance food intake

➣Decrease avoidance of specific foods

➣Deal with distorted thinking about foods, body image, and weight

■Binge eating and purging usually decline once dietary restriction is

eased

■Initial stages of treatment include a detailed self-monitoring of food

intake and the precipitants and consequences of binge eating

■In the later stages of treatment, relapse-prevention techniques are

used (e.g., learning how to cope with high-risk situations)

■Average treatment course: weekly for about 20 sessions over a 6-

month period

■CBT vs. medication:

➣CBT is the preferred initial approach to the treatment of bulimia

nervosa

➣Medication is considered only when the patient does not respond

to an adequate course of CBT

➣50% of the patients will become symptom-free following treat-

ment

➣25% will demonstrate significant improvement

follow-up

Long-term treatment for 6 months:

■Cognitive-behavioral therapy (CBT), aims:

➣Provide support