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Family-based treatment superior to CBT for adolescent bulimia nervosa

Results from a randomized clinical trial indicated family-based treatment for adolescent bulimia nervosa was superior to cognitive behavioral therapy adapted for adolescents in reducing binge eating and purging up to 6 months after treatment.

“Several randomized controlled trials have now tested a range of treatments for adults with [bulimia nervosa]. Overall, results suggest cognitive-behavior therapy (CBT) is the most efficacious approach and therefore the first line treatment for adults with this disorder,” Daniel Le Grange, PhD, of the University of California, San Francisco, and colleagues wrote. “However, despite the fact that bulimic behaviors typically onset during adolescence, there is a paucity of studies evaluating treatments in this age group. Several case series of bulimic adolescents suggest that family therapy or cognitive-behavior therapy adapted for adolescents (CBT-A) is feasible and leads to clinical improvements.”

To compare efficacy of CBT-A with Family-Based Treatment for Adolescent Bulimia Nervosa, researchers conducted a randomized controlled trial among 130 study participants aged 12 to 18 years who met DSM-IV criteria for bulimia nervosa or partial bulimia nervosa. Study participants received 18 sessions of CBT-A or family-based treatment over 6 months. The primary study outcome was abstaining from binge eating and purging for 4 weeks prior to assessment.

Study participants who received family-based treatment had higher abstinence rates than those who received CBT-A at end of treatment (39% vs. 20%; P = .04) and at 6-month follow-up (44% vs. 25%; P = .03). However, abstinence rates did not significantly differ at 12-month follow-up (49% vs. 32%).

“The results of this study support our primary hypothesis that [Family-Based Treatment for Adolescent Bulimia Nervosa] would be superior to CBT-A for adolescents with [bulimia nervosa] at the [end of treatment] and six month follow-up; however, abstinence rates no longer differed statistically by 12-month follow-up,” the researchers wrote. “Of our proposed moderators, family pathology ([Family Environment Scale] conflict) emerged as a significant moderator of treatment effect. That is, participants with lower [Family Environment Scale] conflict scores responded better to [Family-Based Treatment for Adolescent Bulimia Nervosa] compared to CBT-A, but there was no differentiation between these two treatments in families with higher levels of [Family Environment Scale] conflict scores.” – by Amanda Oldt

Disclosure: Le Grange reports receiving royalties from Guilford Press and Routledge, and payments from the Training Institute for Child and Adolescent Eating Disorders, LLC, and funding from the Baker Foundation (Australia), Centers for Recovery (Insight Behavioral Health), National Eating Disorders Association, and Children’s Hospital and Clinics of Minnesota. Please see the full study for a list of all authors’ relevant financial disclosures.