This review evaluated psychological treatments for Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder conducted in primary care. Five studies met inclusion criteria. Guided self-help cognitive-behavioral therapy via a self-help book may be a beneficial, first-line treatment for reducing binging and purging symptoms. Outcomes combining self-help with antidepressants remain unclear, although antidepressants alone may provide reduction of symptoms. High attrition and non-compliance rates among studies reviewed indicate the importance of a strong therapeutic alliance between provider and patient. Further research in primary care is needed to develop a standard of care for patients with eating disorders.
American Psychiatric Association (2000) Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: American Psychiatric Association.
2.
Bacaltchuk J., Hay P. and Mari JJ ( 2000) Antidepressants versus placebo for the treatment of bulimia nervosa: A systematic review. Australian & New Zealand Journal of Psychiatry34(2): 310-317.
3.
Bailer U., De Zwann M., Leisch F., Strnad A. and Lennkh-Wolfsberg C. ( 2004) Guided self-help versus cognitive-behavioral group therapy in the treatment of bulimia nervosa. International Journal of Eating Disorders35(4): 522-537.
4.
*Banasiak SJ, Paxton SJ and Hay P. ( 2005) Guided self-help for bulimia nervosa in primary care: A randomized controlled trial. Psychological Medicine35(9): 1283-1294.
5.
Becker AE ( 2003) Outpatient management of eating disorders in adults. Current Women’s Health Reports3(3): 221-229.
6.
Berkman ND, Bulik CM, Brownley KA, et al. (2006) Management of Eating Disorders: Evidence Report/Technology Assessment No. 135. Prepared by the RTI International-University of North Carolina Evidence-Based Practice Center under Contract No. 290-02-0016. AHRQ Publication No. 06-E010. Rockville, MD: Agency for Healthcare Research and Quality.
7.
*Carter JC and Fairburn CG ( 1998) Cognitive-behavioral self-help for binge eating disorder: A controlled effectiveness study. Journal of Counseling and Clinical Psychology66(4): 616-623.
8.
Centre for Reviews and Dissemination (2001 ) Undertaking Systematic Reviews of Research on Effectiveness: CRD’s Guidance for those Carrying Out or Commissioning Reviews. CRD Report Number 4. York: University of York.
9.
Chen EY, Matthews L., Allen C., Kuo JR and Linehan MM ( 2008) Dialectical behavior therapy for clients with binge-eating disorder or bulimia nervosa and borderline personality disorder. International Journal of Eating Disorders41(6): 505-512.
10.
Cohen J. ( 1988) Statistical Power Analysis for the Behavioral Sciences . New Jersey: Lawrence Erlbaum Associates .
11.
Cooper PJ ( 1993) Bulimia Nervosa: A Guide to Recovery. London: Robinson Publishing.
12.
Cooper PJ ( 1995) Bulimia Nervosa and Binge-Eating: A Guide to Recovery . London: Robinson Publishing.
13.
Crow SJ, Peterson CB, Swanson SA, Raymond NC, Specker S., Eckert ED and Mitchell JE ( 2009) Increased mortality in bulimia nervosa and other eating disorders. American Journal of Psychiatry166(12): 1342-1346.
14.
C.S. MottChildren’s Hospital, the University of Michigan Department of Pediatrics and Communicable Diseases, and the University of Michigan Child Health Evaluation and Research (CHEAR) Unit (2008) C.S. Mott Children’s Hospital National Poll on Children’s Health . Mental Health Services for Children and Adolescents: Missed Opportunities in Primary Care & Barriers to Specialty Care, 5(4).
15.
Currin L., Waller G. and Schmidt U. ( 2009) Primary care physicians’ knowledge of and attitudes toward the eating disorders: Do they affect clinical actions? International Journal of Eating Disorders42(5): 453-458.
16.
*Durand MA and King M. ( 2003) Specialist treatment versus self-help for bulimia nervosa: A randomized controlled trial in general practice. British Journal of General Practice53(490): 371-377.
17.
Eisler I., Dare C., Hodes M., Russell G., Dodge E. and Le Grange D. ( 2000) Family therapy in adolescent anorexia nervosa: The results of a controlled comparison of two family interventions. Journal of Child Psychology and Psychiatry and Allied Disciplines41(6): 727-736.
Fairburn CG ( 1997) Interpersonal psychotherapy for bulimia nervosa. In: Garner DM, Garfinkel PE (eds) Handbook of Treatment for Eating Disorders . New York: Guildford Press, 67-93.
20.
Fairburn CG and Carter JC ( 1996) Self-help and guided self-help for binge eating problems . In: Garner DM, Garfinkel PE (eds) Handbook of Treatment for Eating Disorders. New York: Guilford Press, 494-500.
21.
Fairburn CG, Marcus MD and Wilson GT ( 1993) Cognitive-behavioral therapy for binge eating and bulimia nervosa: A comprehensive treatment manual. In: Fairburn CG, Wilson GT (eds) Binge Eating: Nature, Assessment, and Treatment. New York : Guilford Press, 361-404.
22.
Fichter M., Cebulla M., Quadflieg N. and Naab S. ( 2008) Guided self-help for binge eating/purging anorexia nervosa before inpatient treatment. Psychotherapy Research18(5): 594-603.
23.
Gurney VW and Halmi KA ( 2001) Developing an eating disorder curriculum for primary care providers. Eating Disorders9(2): 97-107.
24.
Hach I., Rentsch A., Ruhl U., et al. (2003) Validity of diagnoses of mental disorders by primary care physicians. Gesundheitswesen65(6): 1-6.
25.
Hach I., Ruhl UE, Rentsch A., et al. (2005) Recognition and therapy of eating disorders in young women in primary care. Journal of Public Health13(3): 160-165.
26.
Hay PJ, Bacaltchuk J., Stefano S. and Kashyap P. ( 2009) Psychological treatments for bulimia nervosa and binging . Cochrane Database of Systematic Reviews4: CD000562.
27.
Hoek HW ( 2006) Incidence, prevalence and mortality of anorexia nervosa and other eating disorders. Current Opinion Psychiatry19(4): 389-394.
28.
Hoek HW and Van Hoeken D. ( 2003) Review of the prevalence and incidence of eating disorders . International Journal of Eating Disorders34(4): 383-396.
29.
Hudson JI, Hiripi E., Pope HG and Kessler RC ( 2007) The prevalence and correlates of eating disorders in the national comorbidity survey replication. Biological Psychiatry61(3): 348-358.
30.
Johnson JG, Spitzer RL and Williams JB ( 2001) Health problems, impairment and illnesses associated with bulimia nervosa and binge eating disorder among primary care and obstetric gynecology patients. Psychological Medicine31(8): 1455-1466.
31.
Jyvasjarvi S., Joukamaa M., Vaisanen E., Larivaara P., Kivela S. and Keinanen-Kiukaanniemi S. ( 2001) Somatizing frequent attenders in primary health care. Journal of Psychosomatic Research50(4): 185-192.
32.
Kondo DG and Sokol MS ( 2006) Eating disorders in primary care: A guide to identification and treatment. Journal of Postgraduate Medicine119(3): 59-65.
33.
Lock J., Agras WS, Bryson S. and Kraemer HC ( 2005) A comparison of short- and long-term family therapy for adolescent anorexia nervosa. Journal of the American Academy of Child & Adolescent Psychiatry44(7): 632-639.
34.
McElroy SL, Arnold LM, Shapira NA, et al. (2003) Topirimate in the treatment of binge eating disorder associated with obesity: A randomized placebo-controlled trial. American Journal of Psychiatry160(2): 255-261.
35.
Pretorius N., Arcelus J., Beecham J., Dawson H., Doherty F., Eisler, I. et al (2009) Cognitive-behavioral therapy for adolescents with bulimic symptomatology: The acceptability and effectiveness of internet-based delivery. Behavioral Research Therapy47(9): 729-736.
36.
Schulz KF, Altman DG and Moher D., for the CONSORT Group (2010) CONSORT 2010 statement: Updated guidelines for reporting parallel group randomized trials. Obstetrics Gynecology115(5): 1063-1070.
37.
Sysko R. and Walsh BT ( 2008) A critical evaluation of the efficacy of self-help interventions for the treatment of bulimia nervosa and binge-eating disorder. International Journal of Eating Disorders41(2): 97-112.
38.
Thielke S., Vannoy S. and Unutzer J. ( 2007) Integrating mental health and primary care. Primary Care Clinics in Office Practice34(3): 571-592.
39.
Toft T., Fink P., Oernboel E., Christensen K., Frostholm L. and Olesen F. ( 2005) Mental disorders in primary care: Prevalence and co-morbidity among disorders. Results from the functional illness in primary care (FIP) study. Psychological Medicine35(8): 1175-1184.
40.
Tsai AG and Wadden TA ( 2009) Treatment of obesity in primary care practice in the United States: A systematic review. Journal of General Internal Medicine24(9): 1073-1079.
41.
US Department of Health and Human Resources (2009) Physician Supply and Demand: Projections to 2020. Washington, DC: US Department of Health and Human Resources. Available at: http://bhpr.hrsa.gov/healthworkforce/reports/physiciansupplydemand/physiciansupplyprojections.htm.
42.
*Waller D., Fairburn CG, McPherson A., Kay R., Lee A. and Nowell T. ( 1996) Treating bulimia nervosa in primary care: A pilot study . International Journal of Eating Disorders19(1): 99-103.
43.
*Walsh BT, Fairburn CG, Mickley D., Sysko R. and Parides MK ( 2004) Treatment of bulimia nervosa in a primary care setting . American Journal of Psychiatry161(3): 556-561.
44.
Walsh BT, Agras WS, Devlin MJ, et al. (2000) Fluoxetine in bulimia nervosa following poor response to psychotherapy. American Journal of Psychiatry157(8): 1332-1333.
45.
Williams PM, Goodie J. and Motsinger CD ( 2008) Treating eating disorders in primary care. American Family Physician77(2): 187-195.
46.
Wilson GT, Grilo CM and Vitousek KM ( 2007) Psychological treatments of eating disorders. American Psychologist62(3): 199-216.
47.
Zhu AJ and Walsh BT ( 2002) Pharmacologic treatment of eating disorders. Canadian Journal of Psychiatry47(3): 227-234.
