Treatment of Bulimia Nervosa in a Primary Care Setting

B. Timothy Walsh, Christopher G. Fairburn, Diane Mickley, Robyn Sysko, Michael K. Parides

Research output: Contribution to journalArticle

94 Citations (Scopus)

Abstract

Objective: The authors' goal was to determine whether treatments known to be effective for bulimia nervosa in specialized treatment centers can be used successfully in primary health care settings. They examined the benefits of two treatments for bulimia: 1) fluoxetine, an antidepressant medication, and 2) guided self-help, an adaptation of cognitive behavior therapy. Method: Ninety-one female patients in two primary care settings were randomly assigned to receive fluoxetine alone, placebo alone, fluoxetine plus guided self-help, or placebo and guided self-help. Results: The majority of the patients did not complete the treatment trial; many patients found the treatment program too demanding, but others indicated it was not sufficiently intensive. Patients assigned to fluoxetine attended more physician visits, exhibited a greater reduction in binge eating and vomiting, and had a greater improvement in psychological symptoms than those assigned to placebo. There was no evidence of benefit from guided self-help. Conclusions: The treatment of patients with bulimia nervosa in a primary care setting is hampered by a high dropout rate. Guided self-help, a psychological treatment based on cognitive behavior therapy, appears ineffective, but treatment with fluoxetine is associated with better retention and substantial symptomatic improvement.

Original languageEnglish (US)
Pages (from-to)556-561
Number of pages6
JournalAmerican Journal of Psychiatry
Volume161
Issue number3
DOIs
StatePublished - Mar 1 2004
Externally publishedYes

Fingerprint

Bulimia Nervosa
Primary Health Care
Fluoxetine
Bulimia
Placebos
Cognitive Therapy
Therapeutics
Psychology
Antidepressive Agents
Vomiting
Physicians

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Treatment of Bulimia Nervosa in a Primary Care Setting. / Walsh, B. Timothy; Fairburn, Christopher G.; Mickley, Diane; Sysko, Robyn; Parides, Michael K.

In: American Journal of Psychiatry, Vol. 161, No. 3, 01.03.2004, p. 556-561.

Research output: Contribution to journalArticle

Walsh, B. Timothy ; Fairburn, Christopher G. ; Mickley, Diane ; Sysko, Robyn ; Parides, Michael K. / Treatment of Bulimia Nervosa in a Primary Care Setting. In: American Journal of Psychiatry. 2004 ; Vol. 161, No. 3. pp. 556-561.
@article{c563157a688d49628a1454034a693717,
title = "Treatment of Bulimia Nervosa in a Primary Care Setting",
abstract = "Objective: The authors' goal was to determine whether treatments known to be effective for bulimia nervosa in specialized treatment centers can be used successfully in primary health care settings. They examined the benefits of two treatments for bulimia: 1) fluoxetine, an antidepressant medication, and 2) guided self-help, an adaptation of cognitive behavior therapy. Method: Ninety-one female patients in two primary care settings were randomly assigned to receive fluoxetine alone, placebo alone, fluoxetine plus guided self-help, or placebo and guided self-help. Results: The majority of the patients did not complete the treatment trial; many patients found the treatment program too demanding, but others indicated it was not sufficiently intensive. Patients assigned to fluoxetine attended more physician visits, exhibited a greater reduction in binge eating and vomiting, and had a greater improvement in psychological symptoms than those assigned to placebo. There was no evidence of benefit from guided self-help. Conclusions: The treatment of patients with bulimia nervosa in a primary care setting is hampered by a high dropout rate. Guided self-help, a psychological treatment based on cognitive behavior therapy, appears ineffective, but treatment with fluoxetine is associated with better retention and substantial symptomatic improvement.",
author = "Walsh, {B. Timothy} and Fairburn, {Christopher G.} and Diane Mickley and Robyn Sysko and Parides, {Michael K.}",
year = "2004",
month = "3",
day = "1",
doi = "10.1176/appi.ajp.161.3.556",
language = "English (US)",
volume = "161",
pages = "556--561",
journal = "American Journal of Psychiatry",
issn = "0002-953X",
publisher = "American Psychiatric Association",
number = "3",

}

TY - JOUR

T1 - Treatment of Bulimia Nervosa in a Primary Care Setting

AU - Walsh, B. Timothy

AU - Fairburn, Christopher G.

AU - Mickley, Diane

AU - Sysko, Robyn

AU - Parides, Michael K.

PY - 2004/3/1

Y1 - 2004/3/1

N2 - Objective: The authors' goal was to determine whether treatments known to be effective for bulimia nervosa in specialized treatment centers can be used successfully in primary health care settings. They examined the benefits of two treatments for bulimia: 1) fluoxetine, an antidepressant medication, and 2) guided self-help, an adaptation of cognitive behavior therapy. Method: Ninety-one female patients in two primary care settings were randomly assigned to receive fluoxetine alone, placebo alone, fluoxetine plus guided self-help, or placebo and guided self-help. Results: The majority of the patients did not complete the treatment trial; many patients found the treatment program too demanding, but others indicated it was not sufficiently intensive. Patients assigned to fluoxetine attended more physician visits, exhibited a greater reduction in binge eating and vomiting, and had a greater improvement in psychological symptoms than those assigned to placebo. There was no evidence of benefit from guided self-help. Conclusions: The treatment of patients with bulimia nervosa in a primary care setting is hampered by a high dropout rate. Guided self-help, a psychological treatment based on cognitive behavior therapy, appears ineffective, but treatment with fluoxetine is associated with better retention and substantial symptomatic improvement.

AB - Objective: The authors' goal was to determine whether treatments known to be effective for bulimia nervosa in specialized treatment centers can be used successfully in primary health care settings. They examined the benefits of two treatments for bulimia: 1) fluoxetine, an antidepressant medication, and 2) guided self-help, an adaptation of cognitive behavior therapy. Method: Ninety-one female patients in two primary care settings were randomly assigned to receive fluoxetine alone, placebo alone, fluoxetine plus guided self-help, or placebo and guided self-help. Results: The majority of the patients did not complete the treatment trial; many patients found the treatment program too demanding, but others indicated it was not sufficiently intensive. Patients assigned to fluoxetine attended more physician visits, exhibited a greater reduction in binge eating and vomiting, and had a greater improvement in psychological symptoms than those assigned to placebo. There was no evidence of benefit from guided self-help. Conclusions: The treatment of patients with bulimia nervosa in a primary care setting is hampered by a high dropout rate. Guided self-help, a psychological treatment based on cognitive behavior therapy, appears ineffective, but treatment with fluoxetine is associated with better retention and substantial symptomatic improvement.

UR - http://www.scopus.com/inward/record.url?scp=1542283787&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=1542283787&partnerID=8YFLogxK

U2 - 10.1176/appi.ajp.161.3.556

DO - 10.1176/appi.ajp.161.3.556

M3 - Article

VL - 161

SP - 556

EP - 561

JO - American Journal of Psychiatry

JF - American Journal of Psychiatry

SN - 0002-953X

IS - 3

ER -