Treatment of Bulimia Nervosa in a Primary Care Setting
Abstract
OBJECTIVE: The authors' goal was to determine whether treatments known to be effective for bulimia nervosa in specialized treatment centers can be used successfully in primary health care settings. They examined the benefits of two treatments for bulimia: 1) fluoxetine, an antidepressant medication, and 2) guided self-help, an adaptation of cognitive behavior therapy. METHOD: Ninety-one female patients in two primary care settings were randomly assigned to receive fluoxetine alone, placebo alone, fluoxetine plus guided self-help, or placebo and guided self-help. RESULTS: The majority of the patients did not complete the treatment trial; many patients found the treatment program too demanding, but others indicated it was not sufficiently intensive. Patients assigned to fluoxetine attended more physician visits, exhibited a greater reduction in binge eating and vomiting, and had a greater improvement in psychological symptoms than those assigned to placebo. There was no evidence of benefit from guided self-help. CONCLUSIONS: The treatment of patients with bulimia nervosa in a primary care setting is hampered by a high dropout rate. Guided self-help, a psychological treatment based on cognitive behavior therapy, appears ineffective, but treatment with fluoxetine is associated with better retention and substantial symptomatic improvement.
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Eating disorders might require approaches that treat the somatic aspects in a clinical setting to regularly control for treatment compliance.
“Eating disorders might require approaches that treat the somatic aspects in a clinical setting to regularly control for treatment compliance [74].”
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- Authors
- Walsh, B. T., Fairburn, C. G., Mickley, D., Sysko, R., & Parides, M. K.
- Affiliations
- Columbia University Irving Medical Center (US)
- Venue
- American Journal of Psychiatry
- Published
- 2004-03-01
- Volume
- 161
- Issue
- 3
- Pages
- 556-561
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- OpenAlex
- W1988836542
- Cited by
- 133
- References
- 23
- Citations by year
- 2025: 2 · 2024: 3 · 2023: 3 · 2022: 1 · 2021: 3 · 2020: 3 · 2019: 2 · 2018: 3 · 2017: 7 · 2016: 6 · 2015: 1 · 2014: 11 · 2013: 8 · 2012: 10
- FWCI
- 15.98
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5r01dk053635-04)
- National Institute of Diabetes and Digestive and Kidney Diseases (DK-53635)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- bulimia nervosa, fluoxetine, guided self-help, cognitive behavioral therapy, primary care, treatment discontinuation, binge eating, vomiting, antidepressant treatment, treatment retention, women
- MeSH terms
- Adult, Bulimia, Combined Modality Therapy, Female, Fluoxetine, Humans, Patient Care Team, Primary Health Care, Programmed Instructions as Topic, Self Care, Cognitive Behavioral Therapy, Treatment Outcome, Selective Serotonin Reuptake Inhibitors
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