Table 2.

Interventions for Bulimia Nervosa.

Author	N (% female)	Recruitment source	Diagnostic/inclusion criteria	Exclusion criteria	Tx conditions (duration and setting)	Primary outcome assessed	Secondary outcome assessed	Primary results	Secondary results
Psychopharmacological Interventions
Antidepressants
Fluoxetine
Walsh et al.50	22 (100)	Poor responders to outpatient CBT or IPT	DSM-III-R BNp		8 weeks Outpatient 60 mg – FLX – PL	Binge, purge episodes in last month, EDE, TFEQ	RSES, BMI, BDI	FLX > PL	FLX = PL
Romano et al.49	150 (98)	Outpatient FLX treatment responders	DSM-IV BNp > 18	Serious psychiatric condition, previous external treatment >4 weeks	52 weeks outpatient relapse prevention 60 mg – FLX – PL	Time to relapse, binge/purge frequency, YCB-EDS	CGI, PGI	FLX > PL	FLX > PL
Fluvoxamine
Milano et al.44	12 (100)		DSM-IV BN		12 weeks Outpatient 200 mg – FLV – PL	Binge/purge episodes	Body weight	FLV > PL	FLV > PL
Sertraline
Milano et al.46	20 (100)	Outpatient	DSM-IV BNp 24–36 years old		12 weeks Outpatient 100 mg – SER – PL	Binge/purge episodes	% body weight reduction	SER > PL	SER > PL
Psychosocial Interventions
Interpersonal Psychotherapy
Agras et al.54	220 (–)	Outpatient	DSM-III-R BNp, >18 years old	Severe psychical or psychiatric condition, current AN, current tx, pregnancy	19 sessions Outpatient – CBT – IPT 1 year follow-up	Recovery and remission rate, binge/purge frequency, EDE	SCL-90-R, RSES, IIP, SAS	CBT > IPT on % remitted and recovered, binge/purge frequency, dietary restraint At follow-up: CBT= IPT	CBT = IPT At follow-up: CBT = IPT
Cognitive Behavioral Therapy
Agras et al.54	220 (–)	Outpatient	DSM-III-R BNp, >18 years old	Severe psychical or psychiatric condition, current AN, current tx, pregnancy	19 sessions Outpatient – CBT – IPT 1 year follow-up	Recovery and remission rate, binge/purge frequency, EDE	SCL-90-R, RSES, IIP, SAS	CBT > IPT on % remitted and recovered, binge/purge frequency, dietary restraint At follow-up: CBT = IPT	CBT = IPT At follow-up: CBT = IPT
Carter et al.61	85 (100)	Waitlist for tx at hospital-based clinic	DSM-IV BNp (≥1 episode/week)	<17 years old, pregnant, medical illness, current psychosocial tx, BMI <18	8 weeks – CBTsh – NSTsh – WL	Frequency of binge and compensatory behaviors, EDI, EDE	RSES, BDI, IIP	CBTsh = NSTsh = WL Simple time effects: CBTsh and NSTsh both had significant decreases in binge/compensatory behaviors over time; WL did not	CBTsh = NSTsh = WL
Bailer et al.59	81 (–)	Community outpatient	DSM-IV BNp >17 years old	Medical instability, severe suicidality	18 weeks Outpatient – gCBT – GSH 1 year follow-up	Monthly frequency of binge/purge episodes, EDI	BDI	gCBT = GSH At follow-up: Guided self-help > gCBT in remission rate	gCBT= GSH
Schmidt et al.56	85 (–)	Community referrals	DSM-IV BN or EDNOS (<2 episodes per week; or purging only), 13–20 years old	BMI < 10th percentile, substance dependence, severe mental illness	13 weeks Outpatient – Family Therapy (FT) – CBTgsh	Abstinence from binge eating, vomiting, EATATE, EDE, ORFI	Health costs	CBTgsh > FT on abstinence of binge eating at 6 months CBTgsh = FT on abstinence of binge eating at 12 months, purging at 6, 12 months	CBTgsh = FT
Dialectical Behavior Therapy
Safer et al.65	31 (100)	Community	Adapted DSM-IV BNp (≥1 episode/week), 18–65 years old	BMI < 17.5, psychosis, suicidality, active drug/alcohol abuse, concurrent tx	20 sessions Outpatient – DBT – WL	Frequency of binge/purge episodes	BDI, NMRS, EES, multi-dimensional personality scale, PANAS, RSES	DBT > WL	DBT = WL
Weight Loss Treatment
Burton and Stice132	85 (100)	University and community outpatient	Adapted DSM-IV BN (≥1 episode/week), 18–55 years old	Treatment in past month, BMI < 19, serious medical or psychiatric condition	Outpatient 6 sessions – HDI – WL	Remission status, binge/compensatory episodes (EDE)	BMI, SAS, health care utilization scale	HDI > WL	HDI > WL for reduction in BMI, health care utilization
Family Based Therapy
LeGrange et al.68	80 (–)	Community and outpatient referrals	DSM-IV BN (≥1 episode/week) for 6 months, 12–19 years old	Substance dependence, BMI < 17.5	20 sessions outpatient – FBT – Supportive Psychotherapy (SPT)	Remission rate (EDE)	K-SADS, BDI, RSES, tx suitability	FT > SPT	FT> SPT on vomiting, compensatory behavior frequency, EDE subscales
Schmidt et al.56	85 (–)	Community referrals	DSM-IV BN or EDNOS (<2 episodes per week; or purging only), 13–20 years old	BMI < 10th percentile, substance dependence, severe mental illness	13 weeks Outpatient – Family Therapy (FT) – CBTgsh	Abstinence from binge eating, vomiting, EATATE, EDE	ORFI, health costs	CBTgsh > FT on abstinence of binge eating at 6 months CBTgsh = FT on abstinence of binge eating at 12 months, purging at 6, 12 months	CBTgsh = FT
Psychopharmacological + Psychosocial Interventions
Mitchell et al.71	91 (100)	Community and outpatient clinic	DSM-III-R BN (≥3 episodes/week) >18 years old, >85% IBW	Serious medical condition, adverse reaction to fluoxetine	16 weeks Outpatient – FLX 60 mg – PL – SH +FLX – SH +PL	Frequency of binge, vomit episodes, EDQ, EDI	HRSD, CGI, PGI	FLX > PL on vomiting SH + FLX, SH +PL > FLX, PL on vomiting	FLX > PL on CGI, PGI
Walsh et al.72	91 (100)	Community	DSM-IV BNp (≥1 episode/week), 18–60 years old, BMI > 17.5	Pregnancy, serious medical or psychiatric illness, concurrent tx	16 weeks Outpatient – FLX – PL – FLX + CBTgsh – PL + CBTgsh	Frequency of binge, vomit episodes, EDE	BDI, SCL-53,	FLX > PL On frequency of binge, vomit episodes, EDE dietary restraint CBTgsh = FLX	FLX > PL CBTgsh = FLX

Note: Greater than symbol (>) refers to significantly better outcome.

Abbreviations: AN, Anorexia Nervosa; BDI, Beck Depression Inventory; BED, Binge Eating Disorder; BMI, Body Mass Index; BN, Bulimia Nervosa; BT, Behavior Therapy; CBT, Cognitive Behavioral Therapy; CGI, Clinical Global Impression; CTRL, Control group; DBT, Dialectical Behavior Therapy; EDI, Eating Disorders Inventory; EDE, Eating Disorders Examination; EES, Emotional Eating Scale; FLX, Fluoxetine; FLV, Fluvoxamine; FT, Family-Based Therapy; g, Group Therapy; gsh, Guided Self Help; HDI, Healthy Diet Intervention; HRSD, Hamilton Rating Scale for Depression; IIP, Inventory of Interpersonal Problems; IMP, Imipramine; IPT, Interpersonal Psychotherapy; K-SADS, Kiddie Schedule of Affective Disorders; NMRS, Negative Mood Regulation Scale; ORFI, Oxford Risk Factor Inventory; NST, Nonspecific Supportive Therapy; PANAS, Positive and Negative Affectivity Scale; PL, Placebo; PGI, Patient Global Improvement; RSES, Rosenberg Self Esteem Scale; SAS, Weissman Social Adjustment Scale; SCL-90, Symptom Checklist; SER, Sertraline; SH, Self Help; SIB, Sibutramine; SM, Self-Monitoring; SPT, Supportive Psychotherapy; TFEQ, Three Factor Eating Questionnaire; TOP, Topiramate; VAS, Visual Analog Scale; WL, Wait List Control; YCB-EDS, Yale Cornell Brown Eating Disorder Scale.