A PROSPECTIVE-STUDY OF OUTCOME IN BULIMIA-NERVOSA AND THE LONG-TERM EFFECTS OF 3 PSYCHOLOGICAL TREATMENTS

Background: Little is known about the longer-term outcome of bulimia n ervosa and the distal effects of treatment. Methods: Prospective follo w-up of subjects from two randomized controlled trials, involving a co mparison of cognitive behavior therapy, behavior therapy, and focal in terpersonal therapy. Results: Ninety percent (89/99) underwent reasses sment by interview (mean [+/-SD] length of follow-up, 5.8+/-2.0 years) . Almost half (46%) had a DSM-IV eating disorder; 19%, bulimia nervosa ; 3%, anorexia nervosa; and 24%, eating disorder not otherwise specifi ed. There was a low rate of other psychiatric disorders. Premorbid and paternal obesity predicted a poor outcome. While the three treatments did not differ with respect to the proportion of subjects with anorex ia nervosa or bulimia nervosa at follow-up, they did differ once all f orms of DSM-IV eating disorder were considered together. Those who had received cognitive behavior therapy or focal interpersonal therapy we re doing markedly better than those who had received behavior therapy. Conclusions: The longer-term outcome of bulimia nervosa depends on th e nature of the treatment received. Patients who receive a treatment s uch as behavior therapy, which only has a short-lived effect, tend to do badly, whereas those who receive treatments such as cognitive behav ior therapy or focal interpersonal therapy have a better prognosis.