A randomized controlled comparison of family-based treatment and supportive psychotherapy for adolescent bulimia nervosa

Arch Gen Psychiatry. 2007 Sep;64(9):1049-56. doi: 10.1001/archpsyc.64.9.1049.


Context: Evidenced-based treatment trials for adolescents with bulimia nervosa are largely absent.

Objective: To evaluate the relative efficacy of family-based treatment (FBT) and supportive psychotherapy (SPT) for adolescents with bulimia nervosa.

Design: Randomized controlled trial.

Setting: The University of Chicago from April 1, 2001, through June 30, 2006.

Participants: Eighty patients, aged 12 to 19 years, with a DSM-IV diagnosis of bulimia nervosa or a strict definition of partial bulimia nervosa.

Interventions: Twenty outpatient visits over 6 months of FBT or SPT. Participants were followed up at 6 months posttreatment.

Main outcome measures: Abstinence from binge-and-purge episodes as measured by the Eating Disorder Examination. Secondary outcome measures were Eating Disorder Examination binge-and-purge frequency and Eating Disorder Examination subscale scores.

Results: Forty-one patients were assigned to FBT and 39 to SPT. Categorical outcomes at posttreatment demonstrated that significantly more patients receiving FBT (16 [39%]) were binge-and-purge abstinent compared with those receiving SPT (7 [18%]) (P = .049). Somewhat fewer patients were abstinent at the 6-month follow-up; however, the difference was statistically in favor of FBT vs SPT (12 patients [29%] vs 4 patients [10%]; P = .05). Secondary outcome assessment, based on random regression analysis, revealed main effects in favor of FBT on all measures of eating pathological features (P = .003 to P = .03 for all).

Conclusions: Family-based treatment showed a clinical and statistical advantage over SPT at posttreatment and at 6-month follow-up. Reduction in core bulimic symptoms was also more immediate for patients receiving FBT vs SPT.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Ambulatory Care
  • Attitude to Health
  • Bulimia Nervosa / psychology
  • Bulimia Nervosa / therapy*
  • Diagnostic and Statistical Manual of Mental Disorders
  • Family Therapy*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Psychiatric Status Rating Scales
  • Psychology, Adolescent
  • Psychotherapy / methods*
  • Regression Analysis
  • Treatment Outcome