A prospective study of outcome in bulimia nervosa and the long-term effects of three psychological treatments

Arch Gen Psychiatry. 1995 Apr;52(4):304-12. doi: 10.1001/archpsyc.1995.03950160054010.


Background: Little is known about the longer-term outcome of bulimia nervosa and the distal effects of treatment.

Methods: Prospective follow-up of subjects from two randomized controlled trials, involving a comparison of cognitive behavior therapy, behavior therapy, and focal interpersonal therapy.

Results: Ninety percent (89/99) underwent reassessment by interview (mean [+/- SD] length of follow-up, 5.8 +/- 2.0 years). Almost half (46%) had a DSM-IV eating disorder; 19%, bulimia nervosa; 3%, anorexia nervosa; and 24%, eating disorder not otherwise specified. There was a low rate of other psychiatric disorders. Premorbid and paternal obesity predicted a poor outcome. 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. Those who had received cognitive behavior therapy or focal interpersonal therapy were doing markedly better than those who had received behavior therapy.

Conclusions: The longer-term outcome of bulimia nervosa depends on the nature of the treatment received. Patients who receive a treatment such as behavior therapy, which only has a short-lived effect, tend to do badly, whereas those who receive treatments such as cognitive behavior therapy or focal interpersonal therapy have a better prognosis.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anorexia Nervosa / diagnosis
  • Anorexia Nervosa / psychology
  • Anorexia Nervosa / therapy
  • Behavior Therapy
  • Bulimia / psychology
  • Bulimia / therapy*
  • Cognitive Behavioral Therapy
  • Female
  • Follow-Up Studies
  • Health Status
  • Humans
  • Probability
  • Prospective Studies
  • Psychotherapy*
  • Severity of Illness Index
  • Social Adjustment
  • Treatment Outcome