Cognitive-behavioral group therapy is especially cost effective for both patients and treatment centers. Group therapy is appealing for patients with BN since they often keep their eating disorder secret and feel isolated, ashamed and embarrassed about their symptoms. There are no controlled studies to assess the efficacy of CBT group therapy in comparison with individual CBT for the treatment of BN.
Over a dozen double-blind, placebo-controlled trials of antidepressants, including amitriptyline, desipramine (Norpramin), fluoxetine, imipramine (Tofranil), nortriptyline (Aventyl, Pamelor) and phenelzine (Nardil), have been conducted in outpatients with BN with normal weight. The dosage of antidepressant medication was similar to that used for the treatment of depression. In all trials, antidepressants were significantly more effective than placebo in reducing binge eating. These medications also improved mood and reduced eating disorder symptoms such as preoccupations with shape and weight. However, the abstinence rate from bingeing and purging was only 22% overall (de Zwaan and Roerig, 2003). Fluoxetine is the only drug approved by the U.S. Food and Drug Administration for the treatment of BN in adults. In general, selective serotonin reuptake inhibitors are preferred for treating BN because of their more benign side-effect profile. There still remains the question of how long BN patients should remain on medication.
There are no treatments that can guarantee a cure for either anorexia nervosa or bulimia nervosa. Continuing research on innovative treatment techniques for both disorders is necessary. It is necessary to recognize that these eating disorders come about via an interaction of environmental influences with a biological or genetic vulnerability. Thus, a better understanding of the biological and genetic factors of these disorders may be helpful in devising more effective treatment strategies.
Dr. Halmi is professor of psychiatry at Cornell University Medical College and director of the eating disorder program at Weill Cornell Medical Center.
Dr. Halmi has indicated she has nothing to disclose regarding the nature of this article.
Boachie A, Goldfield GS, Spettigue W (2003), Olanzapine use as an adjunctive treatment for hospitalized children with anorexia nervosa: case reports. Int J Eat Disord 33(1):98-103.