Current treatment approaches for bulimia are reviewed. The use of hospitalisation and drug therapy is examined. The behavioural and psychodynamic models of treatment, including cognitive-behavioural therapy, behaviour therapy, group therapy and family therapy, and counselling and educational approaches are discussed.
Get full access to this article
View all access options for this article.
References
1.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 3rd edn.Washington DC: APA, 1980.
2.
MartinJ. Bulimia: A literature review. Br J Occup Ther1989; 52: 138–42.
3.
MartinJ. Research methodology used in identifying bulimia. Br J Occup Ther1989; 52: 175–80.
4.
MartinJ. The role of body image in the development of bulimia. Br J Occup Ther1989; 52: 262–65.
5.
HalmiKFalkJSchwartzE. Binge eating and vomiting: A survey of a college population. Psychol Med1981; 11: 697–706.
6.
PyleRHalvorsenPNeumanPGoffG. The incidence of bulimia in freshman college students. Int J Eating Disord1983; 2: 75–86.
7.
HartKOllendickT. Prevalence of bulimia in working and university women. Am J Psychiatry1985; 3: 851–54.
8.
GarnerDGarfinkelPSchwartzDThompsonM. Cultural expectations of thinness in women. Psychol Rep1980; 47: 483–91.
9.
RussellG. Bulimia nervosa: An ominous variant of anorexia nervosa. Psychol Med1979; 9: 429–48.
10.
MitchellJPyleR. The bulimic syndrome in normal weight individuals: A review. Int J Eating Disord1982; 1: 61–73.
11.
Boskind-LodahlMWhiteW. The definition and treatment of bulimarexia in college women — A pilot study. J Am Coll Health Assoc1978; 27: 84–87.
12.
PalmerR. The dietary chaos syndrome: A useful new term. Br J Med Psychol1979; 52: 187–90.
13.
FairburnC. A cognitive behavioural approach to the treatment of bulimia. Psychol Med1981; 11: 707–11.
14.
LaceyH. An outpatient treatment program for bulimia nervosa. Int J Eating Disord1983; 2: 209–14.
15.
PopeHHudsonJJonasJYurgelun-ToddD. Bulimia treated with imipramine: A placebo-controlled double-blind study. Am J Psychiatry1983; 140: 554–58.
16.
GarfinkelPGarnerD. Anorexia nervosa: A multi-dimensional perspective. New York: Brunner Mazel, 1982.
17.
LevittJ. Treating adults with eating disorders by using an inpatient approach. Health Soc Work1986; 11: 133–40.
18.
Schlesier-StroppB. Bulimia: A review of the literature. Psychol Bull1984; 95: 247–57.
19.
GreenRRauT. Treatment of compulsive eating disturbances with anticonvulsant medication. Am J Psychiatry1974; 131: 428–32.
20.
WermuthBDavisKHollisterLStunkardA. Phenytoin treatment of the binge eating syndrome. Am J Psychiatry1977; 134: 1249–53.
21.
MitchellJGroatR. A placebo-controlled double-blind trial of amitriptyline in bulimia. J Clin Psychopharmacol1984; 4: 186–93.
22.
WalshBStewartJRooseSGladisMGlassmanA. Treatment of bulimia with phenelzine. Arch Gen Psychiatry1984; 41: 1105–09.
23.
BrotmanAHerzogDWoodsB. Anti-depressant treatment of bulimia: The relationship between bingeing and depressive symptomatology. J Clin Psychiatry1984; 45: 7–9.
24.
GwirtsmanHRoy-ByrnePYagerJGernerR. Neuroendocrine abnormalities in bulimia. Am J Psychiatry1983; 140: 559–63.
25.
HerzogD. Are anorexic and bulimic patients depressed?Am J Psychiatry1984; 4: 1594–97.
26.
MitchellJPyleRHatsakamiDBoutacoffL. The dexamethasone suppression test in patients with bulimia. J Clin Psychiatry1984;45:508–11.
27.
StewartJWalshBWrightLRooseSGlassmanA. An open trial of monoamine oxidase inhibitors in bulimia. J Clin Psychiatry1984; 45: 217–22.
28.
KronigM. Case report of successful treatment of bulimia with Isocarboxazid. Am J Psychiatry1986; 143: 551–52.
29.
KennedySPiranNGarfinkelP. Monoamine oxidase inhibitor therapy for anorexia nervosa and bulimia: A preliminary trial of Isocarboxazid. J Clin Psychopharmacol1985; 5: 279–85.
30.
SabineEYonaceAFarringtonKBarrattKWakelingA. Bulimia nervosa: A placebo-controlled double-blind therapeutic trial of mianserin. Br J Clin Pharmacol1983; 15: 1955–2025.
31.
PaykelSMuellerPVergneP Dela. Amitriptyline, weight gain and carbohydrate craving. Br J Psychiatry1973; 123: 501–507.
32.
RobinsonPCheckleySRussellG. Suppression of eating by fenfluramine in patients with bulimia nervosa. Br J Psychiatry1985; 146: 168–76.
33.
HsuL. Treatment of bulimia with lithium. Am J Psychiatry1984; 141: 1260–62.
34.
JonasJGoldM. Treatment of antidepressant-resistant bulimia with naltrexone. Int J Psychiatry Med1987; 16: 305–309.
35.
MushlinAAppelA. Diagnosing potential non-compliance. Physician's ability in a behavioural dimension of medical care. Arch Int Med1977; 137: 318–21.
36.
CooperPFairburnC. The depressive symptoms of bulimia nervosa. Br J Psychiatry1986; 148: 268–74.
37.
LongCCordleC. Psychological treatment and self-induced vomiting. Br J Med Psychol1982; 55: 139–45.
38.
LindenW. Multicomponent behaviour therapy in a case of compulsive binge eating followed by vomiting. J Behav Ther Exp Psychiatry1980; 11: 297–300.
39.
SchneiderJAgrasS. A cognitive behavioural group treatment of bulimia. Br J Psychiatry1985; 146: 66–69.
40.
OrdmanAKirschenbaumD. Cognitive-behavioural therapy for bulimia: An initial outcome study. J Consult Clin Psychol1985; 53:305–11.
Boskind-LodahlMWhiteW. Bulimarexia: The binge purge cycle. New York: W W Norton, 1983.
43.
LaceyH. An outpatient treatment program for bulimia nervosa. Int J Eating Disord1983; 2: 209–14.
44.
CooperPCooperZ. Behavioural treatment of bulimia nervosa. Int J Eating Disord1989; 8: 87–92.
45.
RosenJLeitenbergH. Bulimia nervosa: Treatment with exposure and response prevention. Behav Ther1982; 13: 117–24.
46.
SternS. The dynamics of clinical management in the treatment of anorexia nervosa and bulimia: An organising theory. Int J Eating Disord1986; 5: 233–54.
47.
SchwartzH. Bulimia: Psychoanalytic perspectives. J Am Psychoanal Assoc1986; 34: 439–62.
48.
OrbachS. Fat is a feminist issue. London: Paddington Press, 1978.
49.
ShisslakCCragoMSchnapsLSwainB. Interactional group therapy for anorexic and bulimic women. Psychotherapy1986; 23: 598–607.
50.
SykesDCurrieKGrossM. The use of group therapy in the treatment of bulimia. Int J Psychosomatics1987; 34: 7–10.
51.
CoxGMerkelW. A qualitative review of psychosocial treatments for bulimia. J Nerv Ment Dis1989; 177: 77–84.
52.
MerrillCMinesRStarkeyR. The premature dropout in the group treatment of bulimia. Int J Eating Disord1987; 6: 293–300.
53.
BakelandFLundwallL. Dropping out of treatment: A critical review. Psychol Bull1975; 82: 738–83.
54.
LuborskyLAuerbackAChandlerMCohenM. Factors influencing the outcome of psychotherapy: A review of quantitative research. Psychol Bull1971; 75: 145–85.
55.
WhiteWBoskind-WhiteM. An experiential-behavioural approach to the treatment of bulimarexia. Psychother Theory1981; 18: 501–507.
56.
WeissLKatzmanM. Group treatment for bulimia women. Arizona Med1984; 41: 100–104.
57.
FernandezR. Group treatment of bulimia. In: PowersPFernandezZ, eds. Current treatment of anorexia nervosa and bulimia. Switzerland: Kayer, 1984.
58.
GarnerDRockertWOlmstedMJohnsonCCoscinaD. Psychoeducational principles in the treatment of bulimia and anorexia nervosa. In: GarnerDGarfinkelP, eds. Handbook of psychotherapy for anorexia nervosa and bulimia. New York: Guilford Press, 1985.
59.
SchwartzR. Bulimia and family therapy: A case study. Int J Eating Disord1982; 2: 75–82.
60.
SchwartzRBarrettMSabaG. Family therapy for bulimia. In: GamerDGarfinkelP, eds. Handbook of psychotherapy for anorexia nervosa and bulimia. New York: Guilford Press, 1985.
61.
Baker-EnrightAButterfieldPBerkowitzB. Self-help and support groups in the management of eating disorders. In: GarnerDGarfinkelP, eds. Handbook of psychotherapy for anorexia and bulimia. New York: Guilford Press, 1985.
62.
GarnerD. Iatrogenesis in anorexia nervosa and bulimia nervosa. Int J Eating Disord1985; 4: 701–726.
63.
HornakN. Group treatment for bulimia: Bulimics Anonymous. J Coll Stud Personnel1983; 24: 461–63.
64.
LeclairNBerkowitzB. Counselling concerns for the individual with bulimia. Personnel Guidance J1983; 2: 352–55.
WeberKGillinghamW. Group counselling for anorexic and bulimic students. J Coll Stud Personnel1984; 25: 276.
67.
NeumanPHalvorsonP. Anorexia nervosa and bulimia: A handbook for counsellors and therapists. New York: Van Nostrand Reinhold, 1983.
68.
Connor-GreeneP. An educational group treatment program for bulimia. J Am Coll Health1987; 35: 229–31.
69.
KatzmanMWeissLWolchikS. Speak don't eat! Teaching women to express their feelings. Women and Therapy1986; 5: 143–57.
70.
McConaghyNBlaszczynskiA. Imaginal desensitisation: A cost-effective treatment in two shoplifters and a binge-eater resistant to previous therapy. Aust NZ J Psychiatry1988; 2: 78–82.
71.
JohnsonCConnorsMStuckeyM. Short-term group treatment of bulimia: A preliminary report. Int J Eating Disord1983; 2: 199–208.
72.
Roy-ByrnePLee BennerKYagerJ. Group therapy for bulimia: A year's experience. Int J Eating Disord1984; 3: 97–116.
73.
MitchellJHatsukamiDGoffGPyleREckertEDavisL. Intensive outpatient group treatment for bulimia. In: GarnerDGarfinkelP, eds. Handbook of psychotherapy for anorexia nervosa and bulimia. New York: Guilford Press, 1985.
74.
RossiterEWilsonG. Cognitive restructuring and response prevention in the treatment of bulimia nervosa. Behav Res Ther1985; 23: 349–59.
75.
HoageCM. The use of in-session structured eating in the outpatient treatment of bulimia. Cited in: HornyakLBakerE. The experiential therapies for eating disorders. New York: Guilford Press, 1989.
76.
MargittaeKBlouinAPerezE. A study of drop-out and psychopharmacological research with bulimics. Int J Psychiatry Med1986; 16: 297–303.
