Bulimia nervosa: A meta-analysis of psychosocial and pharmacological treatments
Behavior TherapyPublished 1 January 1999
Maureen L. Whittal, W. Stewart Agras, Robert A. Gould
Citations158
SJR quartileQ1
SJR score1.61
SNIP1.41
Generate an AI Snapshot to get a quick, structured summary of this paper.
Study Snapshot
ObjectiveStudy objective
MethodsResearch methodology
PopulationPopulation studied
Sample sizeSample sizes
OutcomesStudy outcomes here
ResultsStudy results comes here
LimitationsResearch study limitations comes here
A concise AI-generated summary of the paper will appear here once you click Generate AI Snapshot.
TL;DR
When compared to medication, cognitive behavioral therapy (CBT) studies produced significantly larger-weighted effect sizes for all treatment outcomes, suggesting that CBT is the treatment of choice for BN.
Abstract
Nine double-blind, placebo-controlled medication trials (870 subjects) and 26 randomized psychosocial studies (460 subjects) were included in a meta-analysis of bulimia nervosa (BN). Four treatment outcomes were analyzed: binge and purge frequency, depression (self-reported and interviewer-rated), and self-reported eating attitudes. When compared to medication, cognitive behavioral therapy (CBT) studies produced significantly larger-weighted effect sizes for all treatment outcomes. These quantitative results correspond to qualitative reviews and suggest that CBT is the treatment of choice for BN.
Keywords
PsychologyBusiness, Management and Accounting
Encyclopedia of Social WorkDiagnostic and Statistical Manual of Mental Disorders
109,983 Citations2013Janet B. W. Williams, Michael B. First
Archives of General PsychiatryAn Inventory for Measuring Depression
38,163 Citations1961Aaron T. Beck
The difficulties inherent in obtaining consistent and adequate diagnoses for the purposes of research and therapy have been pointed out and a wide variety of psychiatric rating scales have been developed.
Journal of Neurology Neurosurgery & PsychiatryA RATING SCALE FOR DEPRESSION
32,633 Citations1960M. Hamilton
The present scale has been devised for use only on patients already diagnosed as suffering from affective disorder of depressive type, used for quantifying the results of an interview, and its value depends entirely on the skill of the interviewer in eliciting the necessary information.
The British Journal of PsychiatryA New Depression Scale Designed to be Sensitive to Change
13,927 Citations1979Stuart Montgomery, Marie Åsberg
The construction of a depression rating scale designed to be particularly sensitive to treatment effects is described, and its capacity to differentiate between responders and non-responders to antidepressant treatment was better than the HRS, indicating greater sensitivity to change.
Journal of Educational StatisticsStatistical Methods for Meta-Analysis
10,479 Citations1988Stanley Wasserman, Larry V. Hedges +1 more
Psychological BulletinThe file drawer problem and tolerance for null results.
8,595 Citations1979Robert Rosenthal
Quantitative procedures for computing the tolerance for filed and future null results are reported and illustrated, and the implications are discussed.
Journal of Psychosomatic ResearchThe three-factor eating questionnaire to measure dietary restraint, disinhibition and hunger
4,701 Citations1985Albert J. Stunkard, Samuel Messick
The first step was a collation of items from two existing questionnaires that measure the related concepts of 'restrained eating' and 'latent obesity', to which were added items newly written to elucidate these concepts.
International Journal of Eating DisordersDevelopment and validation of a multidimensional eating disorder inventory for anorexia nervosa and bulimia
4,535 Citations1983David M. Garner, Marion P. Olmstead +1 more
Psychological MedicineThe Eating Attitudes Test: an index of the symptoms of anorexia nervosa
3,551 Citations1979David M. Garner, Paul E. Garfinkel
The EAT was validated using 2 groups of female anorexia nervosa patients and female control subjects and total EAT score was significantly correlated with criterion group membership, suggesting a high level of concurrent validity.
Elsevier eBooksStatistical Methods for Meta-Analysis
2,526 Citations1985
The aim of this paper is to introduce several widely-used statistical methods of Meta-analysis, applied generally in medical literatures.
Journal of Educational StatisticsA Fail-Safe N for Effect Size in Meta-Analysis
1,729 Citations1983Robert G. Orwin
International Journal of Eating DisordersThe eating disorder examination: A semi-structured interview for the assessment of the specific psychopathology of eating disorders
1,375 Citations1987Zafra Cooper, Christopher G. Fairburn
This interview, the Eating Disorder Examination, is designed to assess the full range of the specific psychopathology of eating disorders, including these patients' extreme concerns about their shape and weight.
New England Journal of MedicineDiscrepancies between Meta-Analyses and Subsequent Large Randomized, Controlled Trials
1,184 Citations1997Jacques LeLorier, Geneviève Grégoire +3 more
The outcomes of the 12 large randomized, controlled trials that were studied were not predicted accurately 35 percent of the time by the meta-analyses published previously on the same topics.
Archives of General PsychiatryThree Psychological Treatments for Bulimia Nervosa
529 Citations1991Christopher G. Fairburn
Cognitive behavior therapy, when applied to patients with bulimia nervosa, operates through mechanisms specific to this treatment and is more effective than both interpersonal psychotherapy and a simplified behavioral version of cognitive behavior therapy.
Archives of General PsychiatryA Prospective Study of Outcome in Bulimia Nervosa and the Long-term Effects of Three Psychological Treatments
529 Citations1995Christopher G. Fairburn
While the three treatments did not differ with respect to the proportion of subjects with anorexia nervosa or bulimia nervosa at follow-up, they did differ once all forms of DSM-IV eating disorder were considered together.
Behavior TherapyCognitive behavioral versus exposure only treatment for social phobia: A meta-analysis
448 Citations1995Ulrike Feske, Dianne L. Chambless
Journal of Behavior Therapy and Experimental PsychiatryMeta-analysis of cognitive-behavioral treatments for social phobia
378 Citations1996Steven Taylor
The results support the use of cognitive-behavioral treatments for social phobia, especially the use for CT + EXP, which had larger effect sizes than placebo but did not differ in drop-out proportions.
Archives of General PsychiatryFluoxetine in the Treatment of Bulimia Nervosa
363 Citations1992
The results indicate that fluoxetine may have a role in the treatment of bulimia and that further investigation is warranted.
American Journal of PsychiatryBulimia treated with imipramine: a placebo-controlled, double-blind study
346 Citations1983Harrison G. Pope, James I. Hudson +2 more
Imipramine was associated with a significantly reduced frequency of binge eating and with improvement on several other measures of eating behavior, which augments the growing evidence that bulimia may be related to affective disorder.
Archives of General PsychiatryA Comparison Study of Antidepressants and Structured Intensive Group Psychotherapy in the Treatment of Bulimia Nervosa
328 Citations1990John C. Mitchell
The addition of antidepressant treatment to the intensive group psychotherapy component did not significantly improve outcome over intensive group Psychotherapy combined with placebo treatment in terms of eating behavior, but did result in more improvement in the symptoms of depression and anxiety.
American Journal of PsychiatryMedication and psychotherapy in the treatment of bulimia nervosa
322 Citations1997B. Timothy Walsh, G. Terence Wilson +6 more
At present, cognitive-behavioral therapy is the psychological treatment of choice for bulimia nervosa and a two-stage medication intervention using fluoxetine adds modestly to the benefit of psychological treatment.
American Journal of PsychiatryPharmacologic and cognitive-behavioral treatment for bulimia nervosa: a controlled comparison
284 Citations1992
American Journal of PsychiatryComparison of cognitive-behavioral and supportive-expressive therapy for bulimia nervosa
273 Citations1993David M. Garner, Wendi Rockert +4 more
Cognitive-behavioral therapy was significantly more effective in ameloriating disturbed attitudes toward eating and weight, depression, poor self-esteem, general psychological distress, and certain personality traits than supportive-expressive therapy.
Behaviour Research and TherapyA comparison of two psychological treatments for bulimia nervosa
267 Citations1986Christopher G. Fairburn, Joan Kirk +2 more
The cognitive behavioural approach was superior to short-term focal psychotherapy in terms of its effect on the patients' overall clinical state, their general psychopathology and social adjustment, and their assessment of their outcome.
BMJBulimia nervosa, binge eating, and psychogenic vomiting: a controlled treatment study and long term outcome.
258 Citations1983J. Hubert Lacey
In 30 women with severe bulimia the treatment programme significantly reduced their incidence of dietary manipulation without producing weight gain, weight disorder, or neurotic illness.
Archives of General PsychiatryTreating Bulimia With Desipramine
233 Citations1986Patrick L. Hughes
A controlled study in patients with bulimia demonstrated a significant benefit from desipramine hydrochloride treatment (91% decrease in binge frequency) in contrast to the results from a placebo (19% increase in frequency).
American Journal of PsychiatryLong-term outcome of antidepressant treatment for bulimia nervosa
220 Citations1991B. Timothy Walsh, Colleen Hadigan +3 more
The study documents a beneficial effect of desipramine in the treatment of bulimia nervosa when compared to placebo, however, limited improvement and considerable relapse with continued treatment suggest serious limitations to the long-term efficacy of a single antidepressant trial.
The British Journal of PsychiatryLong-Term Fluoxetine Treatment of Bulimia Nervosa
217 Citations1995D. Goldstein, Michael G. Wilson +3 more
Fluoxetine appeared to be safe and effective in patients with bulimia nervosa for up to 16 weeks, and adverse event, vital sign and laboratory analyses indicated that fluxetine was safe.
PubMedTreatment of bulimia with bupropion: a multicenter controlled trial.
213 Citations1988Rachel Horne, James M. Ferguson +5 more
In a placebo-controlled, double-blind study of the unique antidepressant agent bupropion in the treatment of nondepressed subjects with bulimia, the drug significantly superior to placebo in reducing episodes of binge eating and purging.
BMJMeta-analysis and the meta-epidemiology of clinical research
210 Citations1997C. David Naylor
This week's BMJ contains a pot-pourri of materials that deal with the research methodology of meta-analysis, with many studies have documented publication bias favouring clinical trials that show a significant treatment effect.
Behaviour Research and TherapyCognitive-behavioral treatment of bulimia nervosa: A controlled evaluation
203 Citations1986G. Terence Wilson, Elise M. Rossiter +2 more
A verbal cognitive restructuring method was compared to CR plus exposure and vomit prevention in the treatment of patients with bulimia nervosa and CR/EVP was significantly more effective in reducing binge eating and vomiting.
Journal of Consulting and Clinical PsychologyExposure plus response-prevention treatment of bulimia nervosa.
190 Citations1988Harold Leitenberg, James C. Rosen +3 more
Journal of Consulting and Clinical PsychologyCognitive-behavioral and response-prevention treatments for bulimia nervosa.
184 Citations1989W. Stewart Agras, John A. Schneider +3 more
International Journal of Eating DisordersImipramine in the treatment of bulimia: A double-blind controlled study
174 Citations1987W. Stewart Agras, Barbara J. Dorian +3 more
Findings from the longest duration medication study in this condition suggest that imipramine is an effective treatment for bulimia, but clinicians may need to add other approaches, such as cognitive-behavioral treatment, to the management of this condition.
Archives of General PsychiatryTreatment of Bulimia With Phenelzine
160 Citations1984B. Timothy Walsh
It is demonstrated that phenelzine is significantly more effective than placebo in the treatment of bulimic patients capable of maintaining a tyramine-free diet and a place for MAOIs is suggested in the treated patients.
Psychological MedicineEndogenous opioid peptides and the control of pain
155 Citations1979H. W. Kosterlitz
The investigation of the analgesic, or rather antinociceptive, properties of the opioid peptides is made difficult by the high sensitivity of the pentapeptides, the enkephalins, to the very rapid degrading actions of aminopeptidase and carboxypeptidases.
Archives of General PsychiatryPhenelzine vs Placebo in 50 Patients With Bulimia
149 Citations1988B. Timothy Walsh
Phenelzine was significantly superior to placebo in the reduction of binge frequency, in the fraction of patients who had ceased bingeing at the end of the trial, and in several measures of psychological state.
Journal of Clinical PsychopharmacologyTreatment of Bulimia with Fenfluramine and Desipramine
143 Citations1988Arthur G. Blouin, Jane Blouin +4 more
Results suggest that direct alteration of central food intake regulatory centers can effectively control bulimic patients and reduce the psychological symptoms of bulimia.
Behaviour Research and TherapyA randomized controlled trial of fluoxetine and cognitive behavioral therapy for bulimia nervosa: Short-term outcome
135 Citations1997David S. Goldbloom, Marion P. Olmsted +5 more
The combination of pharmacotherapy and psychotherapy was superior to pharmacotherapy alone on specific parameters and there was no statistically significant advantage to the combination over psychotherapy alone.
The Canadian Journal of PsychiatryTreatment of Bulimia with Desipramine: A Double-Blind Crossover Study
128 Citations1988Jane Barlow, Jane Blouin +2 more
Desipramine was significantly more effective than placebo in reducing the frequency of weekly hinging, weekly vomiting, and the fatigue scale of the POMS and was associated with an alleviation of depressive symptoms.
BMJControlled trial of psychotherapy for bulimia nervosa
121 Citations1988C. P. Freeman, Fiona Barry +2 more
All three treatments for bulimia nervosa psychotherapy were effective and scores on eating and depression questionnaires were reduced and self esteem improved, and of 24 women available at one year, 21 were not bingeing and had maintained their improved scores on psychometric scales.
International Journal of Eating DisordersCognitive-behavioral group therapy for bulimia
120 Citations1986Nancy F. Lee, A. John Rush
Overall absolute clinical efficacy was limited, as only four treated subjects showed a full remission of binge episodes, and longer treatment with more specifically tailored cognitive- behavioral techniques may be warranted in the search for more efficacious results for bulimia.
Behaviour Research and TherapyComparison of cognitive-behavior therapy and desipramine in the treatment of bulimia nervosa
119 Citations1994Harold Leitenberg, James C. Rosen +4 more
It was apparent that at posttreatment and at 6 months follow-up no benefit was being realized from combining cognitive-behavior therapy with desipramine.
The Biology of Feast and Famine: Relevance to Eating Disorders
105 Citations1992G. Harvey Anderson, Sidney H. Kennedy +1 more
Part 1 Control mechanisms in feeding: bulimia nervosa - a syndrome of feast and famine, B.T. Walsh and A.M.
Journal of Clinical PsychopharmacologyA Placebo-Controlled Study of Trazodone in Bulimia Nervosa
103 Citations1989Harrison G. Pope, Paul E. Keck +2 more
The drug proved significantly superior to placebo, both in measures of frequency of binge eating and vomiting and in the patients' subjective assessments of improvement.
Journal of Psychosomatic ResearchPsychotherapy of bulimia nervosa: What is effective? A meta-analysis
96 Citations1992Armin Hartmann, Thomas Herzog +1 more
The present paper assesses the state of the art of psychotherapy of bulimia nervosa by systematically screened publications available up to April 1990 and found no definite advantage of one setting or therapeutic approach over another.
Behaviour Research and TherapyA comparison of two psychological treatments for bulimia nervosa: Implications for models of maintenance
96 Citations1995Peter Cooper, Jane Steere
The two treatment groups could not be distinguished on post-treatment measures of cognitive disturbance and neither was it the case that residual levels of cognitive disturbances predicted relapse, which may suggest that the level at which the necessary cognitive change takes place may not be accessible by conventional assessment procedures.
Behaviour Research and TherapyCognitive-behavioral treatment with and without response prevention for Bulimia
89 Citations1991G. Terence Wilson, Kathleen L. Eldredge +2 more
CBT with and without exposure and response prevention in the treatment of eating disorder patients who both binged and purged, and reported abnormal attitudes concerning body weight and shape produce significant and comparable reductions in binge-eating and purging.
Clinical Psychology ReviewWhat meta-analyses have and have not taught us about psychotherapy effects: A review and future directions
88 Citations1997Georg E. Matt
There is currently little agreement in the reviewed meta-analyses concerning the limits of the apparent robustness of intervention effects, and variables considered as potential moderators of psychotherapy effects are frequently confounded with other study characteristics.
Journal of Clinical PsychopharmacologyA Trial of Isocarboxazid in the Treatment of Bulimia Nervosa
83 Citations1988Sidney H. Kennedy, Niva Piran +5 more
There was a significant reduction in binge eating and vomiting during isocarboxazid treatment, and there were no serious adverse effects from this monoamine oxidase inhibitor therapy, although over 50% of patients elected to discontinue isocara boxazid 1 year after the study.
The British Journal of PsychiatryA Comparison of Nutritional Management with Stress Management in the Treatment of Bulimia Nervosa
81 Citations1991Reinhold G. Laessle, P. J. V. Beumont +6 more
NM produced a more rapid improvement in general eating behaviour, a faster reduction in binge frequency and a higher abstinence rate from binge eating, and SM led to greater positive changes in certain psychopathological features such as feelings of ineffectiveness, interpersonal distrust and anxiety.
Journal of Consulting and Clinical PsychologyA comparison of behavioral and cognitive-behavioral interventions for bulimia nervosa.
78 Citations1993Donna Thackwray, Michael C. Smith +2 more
Journal of Clinical PsychopharmacologyIs There a Role for Selective Monoamine Oxidase Inhibitor Therapy in Bulimia Nervosa? A Placebo-Controlled Trial of Brofaromine
77 Citations1993Sidney H. Kennedy, David S. Goldbloom +4 more
Bfaromine produced a significant effect in decreasing episodes of vomiting throughout the trial, although comparable reductions in episodes of binge eating were found in both groups, and there were no advantages of drug over placebo on improvements in attitudinal measures and shape or on self-report ratings of depression and anxiety.
International Journal of Eating DisordersAn evaluation of behavioral and cognitive-behavioral group interventions for the treatment of bulimia nervosa in women
60 Citations1992Eve M. Wolf, Janis H. Crowther
The research on the treatment of bulimia nervosa: practical and theoretical implications
46 Citations1992Christopher G. Fairburn, W. Stewart Agras +1 more
Clinical Psychology ReviewMeta-analysis of cognitive-behavioral treatment studies for bulimia
43 Citations1997L Lewandowski
Overall, results suggest that the use of a cognitive-behavioral therapy will result in favorable treatment outcomes and implications for future research are discussed.
International Journal of Eating DisordersMetaanalysis of treatment studies for bulimia
41 Citations1987Reinhold G. Laessle, Cornelia Zoettl +1 more
A metaanalysis of 25 outcome studies considered the relative effectiveness of drug therapy and psychological therapy in the treatment of bulimia and suggested that psychotherapy in general and especially when combined with dietary management was superior to drug therapy.
Psychiatry ResearchComparing the cost effectiveness of psychiatric treatments: bulimia nervosa
27 Citations1995Martín Keller, W. Stewart Agras +8 more
An exploratory post hoc study that compared the cost effectiveness of five treatments for bulimia nervosa shows how a treatment's cost effectiveness varies according to when evaluation is done and how effectiveness and cost are defined.
BMJThe beginning of the end of the internal market
1 Citations1997J. Warden
1998-9 is to be a transitional year in which the planning and delivery of health services reflect the emerging new …