Efficacy of psychotherapy in bulimia nervosa

The efficacy and importance of psychotherapy in bulimia nervosa have been examined in many studies recently. Most of the eating disorder experts acknowledge the notion that psychological interventions are the best available treatment for BN. Although different psychotherapeutic recommendations have been offered by NICE (National Institute for Health and Clinical Excellence) and APA (American Psychiatric Association), several treatment approaches received strong endorsement for BN. Cognitive behavioral therapy (CBT) is recommended as an effective treatment for bulimic patients and considered the 'treatment choice' for BN and binge eating disorder (BED), it is also supported by strong evidence-based literature.

With regard to the efficacy of CBT specifically in BN, in various studies CBT was associated with more improvements in bulimic and depressive symptoms of patients than symtoms of control patients in waiting-list and any other psychotherapy cases. In terms of general psychiatric symptoms, studies have not shown any difference between CBT and any other psychotherapy.

Other psychotherapy choices have included interpersonal psychotherapy (IPT), dialectical behavior therapy, supportive and psychodynamic psychotherapy, and certain self-help approaches. Thus, in clinical practice there have been a number of evidence-supported treatments for BN patients.

IPT is a psychological treatment for BN that has demonstrated long-term outcomes that are comparable to those for CBT. Currently, all controlled studies of IPT for BN have been comparison studies with CBT. Although there have been only few controlled trials of psychodynamic treatment of eating disorders, these reports yielded important findings in this field. Standard dialectical behavior therapy (DBT) has been adapted to address a variety of problematic behaviors associated with emotion dysregulation in bulimia nervosa and also DBT may be used in BN patients with comorbid borderline personality disorder. Beside these, the knowledge in the field of self-help treatments continues to develope.