Summary

This randomized controlled trial found that for patients with bulimia nervosa, CBT was more effective in relieving binging and purging than psychoanalytic psychotherapy, and achieved results faster.

Design

• Randomized controlled trial.
• N=70 patients meeting DSM-IV criteria for bulimia nervosa randomized to:
  • 2 years of weekly psychoanalytic psychotherapy (n=23 completed).
  • 5 months of CBT, 20 sessions total (n=27 completed).
• Setting: University outpatient clinic in Denmark, 2004-2008.
• Participants were almost entirely female (1/70 male), mean age 25.8, mean duration of eating disorder features 12.3 years, mean baseline BMI 22.6, 37% had history of anorexia nervosa, 59% were previously treated for eating disorder.
• Primary outcome: cessation of binge/purge behavior over previous 28 days, assessed at 5 and 24 months.
• Secondary outcomes:
  • Eating disorder psychopathology was assessed using the Eating Disorder Examination (EDE) interview.
  • Body Mass Index (BMI)
  • Beck Depression Inventory (BDI)
  • Inventory of Personality Problems (IPP)

Results

• At 5 months, CBT was associated with a significantly greater rate of cessation of binging/purging compared with psychoanalytic psychotherapy (OR=13.40, 95% CI=2.45-73.42, P<0.01):
  • CBT: 42%
  • Psychoanalytic: 6%
• At their respective endpoints, CBT was associated with a significantly greater rate of cessation of binging/purging compared with psychoanalytic psychotherapy (OR=4.41, 95% CI=1.20-16.15, P=0.03):
  • CBT: 42% at 5 months
  • Psychoanalytic: 15% at 24 months
• Rate of cessation of binge/purse behavior was maintained in the CBT group long after completion of CBT:
  • 42% at 5 months
  • 44% at 24 months
• In most secondary outcomes measures, improvements were more rapid in the CBT group, but lost significance at 24 months, as the psychoanalytic group caught up to the CBT group, as seen with Beck’s Depression Inventory (BDI).
• BDI scores at 5 months (P=0.001):
  • 8.89 for CBT
  • 15.05 for Psychoanalytic
• BDI scores at 24 months (P=0.867):
  • 7.52 for CBT
  • 7.85 for Psychoanalytic
• BMI did not differ significantly between the groups at any time.

Reference

Poulsen S, Lunn S, Daniel SIF, et al. A randomized controlled trial of psychoanalytic psychotherapy or cognitive-behavioral therapy for bulimia nervosa. Am J Psychiatry. 2014;171(1):109-116. doi:10.1176/appi.ajp.2013.12121511.