TREATMENT OF BULIMIA-NERVOSA - WHEN CBT FAILS

Controlled studies have established manual-based cognitive-behavioral therapy (CBT) is the first-line treatment of choice for bulimia nervos a; Nevertheless, its effectiveness is limited. On average, only 50% of patients cease binge eating and purging. Of the remainder, some show partial improvement, whereas a small number derive no benefit at all. In treating nonresponders to CBT one option would be to use antidepres sant medication. A second would be to adopt interpersonal psychotherap y (IPT), an alternative psychological therapy with empirical support. However, both options have failed to reduce binge eating following uns uccessful CBT. Treating nonresponders is hampered by the lack of treat ment-specific predictor variables. Comorbid personality disorder is as sociated with a poorer response not only to CBT but also alternative t herapies. There is no evidence that psychodynamic therapy is effective with complex cases with associated psychopathology. A third option is to use more expanded or intensive CBT. An example of the latter would be concentrated exposure within an inpatient setting. The relative me rits of adhering to manual-based treatment versus allowing therapists free reign in individual case formulation are discussed.