A comparison of family based treatment and supportive psychotherapy in teenagers with Bulimia Nervosa
le Grange D, Crosby RD, Rathouz PJ, Leventhal BL.
The Issue
Symptoms of bulimia nervosa (BN) are found in up to 5% of teenagers, yet there has been little research into effective treatments for this age group. Teenagers and adults with this eating disorder have episodes during which they eat very large amounts of food, and then make themselves vomit or use laxatives to get rid of the food. Many people with this condition also have problems with depression or anxiety. It is not known if the therapies used for adults with BN work for teenagers, too.
The Research
This was a randomized controlled trial comparing family-based therapy to supportive psychotherapy in teenagers with bulimia nervosa. The participants were between 12 and 19 years of age. All had received a diagnosis of bulimia nervosa or had definite symptoms of the condition. Forty-one were assigned to take part in family-based therapy and 39 were assigned to receive supportive psychotherapy. The treatment consisted of 20 sessions delivered over a six-month period.
In the family-based treatment group, parents were taught how to keep their teen children from overeating and purging and were initially put in charge of preventing these behaviours.. Control over their own behavior was eventually turned over to the adolescent.
The supportive psychotherapy involved development of a good working relationship between the teenager and therapist, helping her/him look at and resolve their emotional problems, and teaching them to become independent in dealing with their emotional issues. The test of treatment success was whether or not the teenagers continued to overeat and purge; remained preoccupied with weight or eating issues; or were still depressed or had low self esteem.
The Outcome
Compared to the supportive therapy group, the adolescents in the family-based therapy group were more likely to recover completely or to have good symptom improvement at the end of the study and at 6 months follow up.
Conclusions
This evidence is promising, but the abstinence rate of 30 to 40% leaves room for improvement. For the present, family based therapy is the treatment of choice.
The preceding is a summary of:
le Grange D, Crosby RD, Rathouz PJ, Leventhal BL. A randomized controlled comparison of family-based treatment and supportive psychotherapy for adolescent bulimia nervosa. Archives of General Psychiatry. 2007; 64(9): 1049-1056.
^top
