Abstract
In this chapter, we provide a broad overview of the treatment of bulimia nervosa among adolescents. First, we describe the disorder prevalence and diagnostic criteria, along with commonly comorbid conditions. We then detail evidence regarding the most efficacious treatments for this disorder and some treatments that show promise and warrant further investigation. Finally, we provide discussion of challenges associated with the treatment of bulimia nervosa among youth and suggest future directions in clinical practice and research.
This is a preview of subscription content, log in via an institution to check access.
Abbreviations
- ACT:
-
Acceptance and commitment therapy
- AN:
-
Anorexia nervosa
- ARFID:
-
Avoidant-restrictive food intake disorder
- BN:
-
Bulimia nervosa
- BED:
-
Binge eating disorder
- CBT:
-
Cognitive-behavioral therapy
- CBT-E:
-
Cognitive-behavioral therapy enhanced for eating disorders
- DBT:
-
Dialectical behavior therapy
- DBT:
-
Dialectical behavioral therapy
- DSM:
-
Diagnostic and Statistical Manual of Mental Disorders
- ED:
-
Eating disorder
- EDE:
-
Eating disorder examination
- EDE-Q:
-
Eating disorder examination-questionnaire
- EDNOS:
-
Eating disorder not otherwise specified
- EOT:
-
End of treatment
- FBT:
-
Family-based treatment
- IPT:
-
Interpersonal therapy
- ICAT:
-
Integrative cognitive-affective therapy
- OSFED:
-
Other specified feeding or eating disorder
- RCT:
-
Randomized control trial
- RO-DBT:
-
Radically open dialectical behavior therapy
- SPT:
-
Individual supportive therapy
References
Agras WS et al (2000) A multicenter comparison of cognitive-behavioral therapy and interpersonal psychotherapy for bulimia nervosa. Arch Gen Psychiatry 57(5):459. https://doi.org/10.1001/archpsyc.57.5.459
Ali K et al (2020) What prevents young adults from seeking help? Barriers toward help-seeking for eating disorder symptomatology. Int J Eat Disord 53(6):894–906. https://doi.org/10.1002/eat.23266
American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. American Psychiatric Association. https://doi.org/10.1176/appi.books.9780890425596
American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders, 4th edn – Revised. American Psychiatric Association
Bagaric M et al (2020) Are bulimia nervosa and binge eating disorder increasing? Results of a population-based study of lifetime prevalence and lifetime prevalence by age in South Australia. Eur Eat Disord Rev 28(3):260–268. https://doi.org/10.1002/erv.2726
Baudinet J et al (2020) Targeting maladaptive overcontrol with radically open dialectical behaviour therapy in a day programme for adolescents with restrictive eating disorders: an uncontrolled case series. J Eat Disord 8(1):68. https://doi.org/10.1186/s40337-020-00338-9
Bodell LP et al (2011) The impact of perceived social support and negative life events on bulimic symptoms. Eat Behav 12(1):44–48. https://doi.org/10.1016/j.eatbeh.2010.11.002
Bottera AR, Kambanis PE, De Young KP (2020) The differential associations of shame and guilt with eating disorder behaviors. Eat Behav 39:101427. https://doi.org/10.1016/j.eatbeh.2020.101427
Calero-Elvira A et al (2009) Meta-analysis on drugs in people with eating disorders. Eur Eat Disord Rev 17(4):243–259. https://doi.org/10.1002/erv.936
Ciao AC et al (2015) Predictors and moderators of psychological changes during the treatment of adolescent bulimia nervosa. Behav Res Ther 69:48–53. https://doi.org/10.1016/j.brat.2015.04.002
Couturier J et al (2019) Psychotropic medication for children and adolescents with eating disorders. Child Adolesc Psychiatr Clin N Am 28(4):583–592. https://doi.org/10.1016/j.chc.2019.05.005
Couturier J et al (2020) Canadian practice guidelines for the treatment of children and adolescents with eating disorders. J Eat Disord 8(1):4. https://doi.org/10.1186/s40337-020-0277-8
Couturier J, Kimber M, Szatmari P (2013) Efficacy of family-based treatment for adolescents with eating disorders: a systematic review and meta-analysis. Int J Eat Disord 46(1):3–11. https://doi.org/10.1002/eat.22042
Crow SJ et al (2014) Suicidal behavior in adolescents and adults with bulimia nervosa. Compr Psychiatry 55(7):1534–1539. https://doi.org/10.1016/j.comppsych.2014.05.021
Crow SJ (2019) Pharmacologic treatment of eating disorders. Psychiatr Clin N Am 42(2):253–262. https://doi.org/10.1016/j.psc.2019.01.007
Dalle Grave R et al (2013) Enhanced cognitive behaviour therapy for adolescents with anorexia nervosa: an alternative to family therapy? Behav Res Ther 51(1):R9–R12. https://doi.org/10.1016/j.brat.2012.09.008
Eddy KT et al (2008) Diagnostic crossover in anorexia nervosa and bulimia nervosa: implications for DSM-V. Am J Psychiatr 165:245–250
Eist HI (2015) DBT skills training manual, 2nd edn. Marsha M. Linehan (2015) The Guilford Press, New York, 504 pp. DBT skills training handouts and worksheets, 2nd edn. Marsha M. Linehan (2015) New York: The Guilford Press. 422 pp. J Nerv Ment Dis 203(11):887. https://doi.org/10.1097/NMD.0000000000000387
Fairburn CG (2008) Cognitive behavior therapy and eating disorders. Guilford Press
Fichter MM, Quadflieg N, Hedlund S (2008) Long-term course of binge eating disorder and bulimia nervosa: relevance for nosology and diagnostic criteria. Int J Eat Disord 41(7):577–586. https://doi.org/10.1002/eat.20539
Forbush KT et al (2017) Understanding eating disorders within internalizing psychopathology: a novel transdiagnostic, hierarchical-dimensional model. Compr Psychiatry 79:40–52. https://doi.org/10.1016/j.comppsych.2017.06.009
Gaudiani JL (2018) Sick enough: a guide to the medical complications of eating disorders, 1st edn. Routledge, 2019, New York. https://doi.org/10.4324/9781351184731
Gordon RA (2015) The history of bulimia nervosa. In: Smolak L, Levine MP (eds) The Wiley handbook of eating disorders. Wiley, Chichester, UK, pp 25–38. https://doi.org/10.1002/9781118574089.ch3
Gorrell S et al (2020) Psychotropic medication use in treatment-seeking youth with eating disorders. Eur Eat Disord Rev 28(6):739–749. https://doi.org/10.1002/erv.2788
Hagan KE, Walsh BT (2021) State of the art: the therapeutic approaches to bulimia nervosa. Clin Ther 43(1):40–49. https://doi.org/10.1016/j.clinthera.2020.10.012
Hamadi L, Holliday J (2020) Moderators and mediators of outcome in treatments for anorexia nervosa and bulimia nervosa in adolescents: a systematic review of randomized controlled trials. Int J Eat Disord 53(1):3–19. https://doi.org/10.1002/eat.23159
Hayes SC (2004) Acceptance and commitment therapy, relational frame theory, and the third wave of behavioral and cognitive therapies. Behav Ther 35(4):639–665. https://doi.org/10.1016/S0005-7894(04)80013-3
Hill DM, Craighead LW, Safer DL (2011) Appetite-focused dialectical behavior therapy for the treatment of binge eating with purging: a preliminary trial. Int J Eat Disord 44(3):249–261. https://doi.org/10.1002/eat.20812
Hudson JI et al (2007) The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol Psychiatry 61(3):348–358. https://doi.org/10.1016/j.biopsych.2006.03.040
Juarascio AS et al (2021) Mindfulness and acceptance-based behavioral treatment for bulimia-spectrum disorders: a pilot feasibility randomized trial. Int J Eat Disord 54(7):1270–1277. https://doi.org/10.1002/eat.23512
Kamody RC, Grilo CM, Udo T (2020) Disparities in DSM-5 defined eating disorders by sexual orientation among U.S. adults. Int J Eat Disord 53(2):278–287. https://doi.org/10.1002/eat.23193
Karam AM et al (2019) Interpersonal psychotherapy and the treatment of eating disorders. Psychiatr Clin N Am 42(2):205–218. https://doi.org/10.1016/j.psc.2019.01.003
Kotler LA et al (2003) An open trial of fluoxetine for adolescents with bulimia nervosa. J Child Adolesc Psychopharmacol 13(3):329–335. https://doi.org/10.1089/104454603322572660
Kraemer HC et al (2002) Mediators and moderators of treatment effects in randomized clinical trials. Arch Gen Psychiatry 59(10):877. https://doi.org/10.1001/archpsyc.59.10.877
Le Grange D et al (2004) Bulimia nervosa in adolescents: a disorder in evolution? Arch Pediatr Adolesc Med 158(5):478. https://doi.org/10.1001/archpedi.158.5.478
Le Grange D et al (2007) A randomized controlled comparison of family-based treatment and supportive psychotherapy for adolescent bulimia nervosa. Arch Gen Psychiatry 64(9):1049. https://doi.org/10.1001/archpsyc.64.9.1049
Le Grange D, Lock J (2007) Treating bulimia in adolescents: a family-based approach. Guilford Press
Le Grange D, Loeb KL (2007) Early identification and treatment of eating disorders: prodrome to syndrome. Early Interv Psychiatry 1(1):27–39. https://doi.org/10.1111/j.1751-7893.2007.00007.x
Le Grange D et al (2012) Moderators and mediators of remission in family-based treatment and adolescent focused therapy for anorexia nervosa. Behav Res Ther 50(2):85–92. https://doi.org/10.1016/j.brat.2011.11.003
Le Grange D et al (2015) Randomized clinical trial of family-based treatment and cognitive-behavioral therapy for adolescent bulimia nervosa. J Am Acad Child Adolesc Psychiatry 54(11):886–894.e2. https://doi.org/10.1016/j.jaac.2015.08.008
Le Grange D et al (2020) Enhanced cognitive-behavior therapy and family-based treatment for adolescents with an eating disorder: a non-randomized effectiveness trial. Psychol Med:1–11. https://doi.org/10.1017/S0033291720004407
Le Grange D, Crosby RD, Lock J (2008) Predictors and moderators of outcome in family-based treatment for adolescent bulimia nervosa. J Am Acad Child Adolesc Psychiatry 47(4):464–470. https://doi.org/10.1097/CHI.0b013e3181640816
Levinson C, Brosof L (2016) Cultural and ethnic differences in eating disorders and disordered eating behaviors. Curr Psychiatr Rev 12(2):163–174. https://doi.org/10.2174/1573400512666160216234238
Lock J (2015) An update on evidence-based psychosocial treatments for eating disorders in children and adolescents. J Clin Child Adolesc Psychol 44(5):707–721. https://doi.org/10.1080/15374416.2014.971458
Lock J, Le Grange D (2019) Family-based treatment: where are we and where should we be going to improve recovery in child and adolescent eating disorders. Int J Eat Disord 52(4):481–487. https://doi.org/10.1002/eat.22980
Lundgren JD, Danoff-Burg S, Anderson DA (2004) Cognitive-behavioral therapy for bulimia nervosa: an empirical analysis of clinical significance. Int J Eat Disord 35(3):262–274. https://doi.org/10.1002/eat.10254
Markowitz JC, Weissman MM (2004) Interpersonal psychotherapy: principles and applications. World Psychiatry 3(3):136–139
Merwin RM, Zucker NL, Timko CA (2013) A pilot study of an acceptance-based separated family treatment for adolescent anorexia nervosa. Cogn Behav Pract 20(4):485–500. https://doi.org/10.1016/j.cbpra.2012.11.001
Mitchison D et al (2020) DSM-5 full syndrome, other specified, and unspecified eating disorders in Australian adolescents: prevalence and clinical significance. Psychol Med 50(6):981–990. https://doi.org/10.1017/S0033291719000898
Nagata et al (2020) Community norms for the eating Disorder Examination Questionnaire (EDE-Q) among transgender men and women Eat Behav [Preprint]. https://doi.org/10.1016/j.eatbeh.2020.101381
National Collaborating Centre for Mental Health (UK) (2004) Eating disorders: core interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders. British Psychological Society (UK) (National Institute for Health and Clinical Excellence: Guidance), Leicester. http://www.ncbi.nlm.nih.gov/books/NBK49304/. Accessed 15 Nov 2021
Nicdao EG, Hong S, Takeuchi DT (2007) Prevalence and correlates of eating disorders among Asian Americans: results from the national Latino and Asian American study. Int J Eat Disord 40(S3):S22–S26. https://doi.org/10.1002/eat.20450
Peebles R, Sieke EH (2019) Medical complications of eating disorders in youth. Child Adolesc Psychiatr Clin N Am 28(4):593–615. https://doi.org/10.1016/j.chc.2019.05.009
Phillipou A et al (2020) Eating and exercise behaviors in eating disorders and the general population during the COVID -19 pandemic in Australia: initial results from the COLLATE project. Int J Eat Disord 53(7):1158–1165. https://doi.org/10.1002/eat.23317
Puhl R, Suh Y (2015) Stigma and eating and weight disorders. Curr Psychiatry Rep 17(3):10. https://doi.org/10.1007/s11920-015-0552-6
Quadflieg N, Fichter MM (2019) Long-term outcome of inpatients with bulimia nervosa – results from the Christina Barz study. Int J Eat Disord 52(7):834–845. https://doi.org/10.1002/eat.23084
Russell G (1979) Bulimia nervosa: an ominous variant of anorexia nervosa. Psychol Med 9(3):429–448. https://doi.org/10.1017/S0033291700031974
Schmidt U et al (2007) A randomized controlled trial of family therapy and cognitive behavior therapy guided self-care for adolescents with bulimia nervosa and related disorders. Am J Psychiatr 164(4):591–598. https://doi.org/10.1176/ajp.2007.164.4.591
Seitz J et al (2013) The role of impulsivity, inattention and comorbid ADHD in patients with Bulimia nervosa. PLoS One. Edited by A. Reif, 8(5): e63891. https://doi.org/10.1371/journal.pone.0063891
Serra R et al (2021) The transition from restrictive anorexia nervosa to binging and purging: a systematic review and meta-analysis. Eat Weight Disord Stud Anorexia Bulimia Obesity [Preprint]. https://doi.org/10.1007/s40519-021-01226-0
Silén Y et al (2020) DSM-5 eating disorders among adolescents and young adults in Finland: a public health concern. Int J Eat Disord 53(5):790–801. https://doi.org/10.1002/eat.23236
Slade E et al (2018) Treatments for bulimia nervosa: a network meta-analysis. Psychol Med 48(16):2629–2636. https://doi.org/10.1017/S0033291718001071
Smink FRE, van Hoeken D, Hoek HW (2012) Epidemiology of eating disorders: incidence, prevalence and mortality rates. Curr Psychiatry Rep 14(4):406–414. https://doi.org/10.1007/s11920-012-0282-y
Solmi M et al (2021) Age at onset of mental disorders worldwide: large-scale meta-analysis of 192 epidemiological studies. Mol Psychiatry [Preprint]. https://doi.org/10.1038/s41380-021-01161-7
Stefini A et al (2017) Cognitive-behavioral and psychodynamic therapy in female adolescents with bulimia nervosa: a randomized controlled trial. J Am Acad Child Adolesc Psychiatry 56(4):329–335. https://doi.org/10.1016/j.jaac.2017.01.019
Steiger H (2017) Evidence-informed practices in the real-world treatment of people with eating disorders. Eat Disord 25(2):173–181. https://doi.org/10.1080/10640266.2016.1269558
Steinhausen H-C, Weber S (2009) The outcome of bulimia nervosa: findings from one-quarter century of research. Am J Psychiatr 166(12):1331–1341. https://doi.org/10.1176/appi.ajp.2009.09040582
Stice E et al (2009) An 8-year longitudinal study of the natural history of threshold, subthreshold, and partial eating disorders from a community sample of adolescents. J Abnorm Psychol 118(3):587–597. https://doi.org/10.1037/a0016481
Stice E et al (2021) Sequencing of symptom emergence in anorexia nervosa, bulimia nervosa, binge eating disorder, and purging disorder and relations of prodromal symptoms to future onset of these disorders. J Abnorm Psychol 130(4):377–387. https://doi.org/10.1037/abn0000666
Stice E, Marti CN, Rohde P (2013) Prevalence, incidence, impairment, and course of the proposed DSM-5 eating disorder diagnoses in an 8-year prospective community study of young women. J Abnorm Psychol 122(2):445–457. https://doi.org/10.1037/a0030679
Swanson SA (2011) Prevalence and correlates of eating disorders in adolescents: results from the National Comorbidity Survey Replication Adolescent Supplement. Arch Gen Psychiatry 68(7):714. https://doi.org/10.1001/archgenpsychiatry.2011.22
Tanofsky-Kraff M et al (2011) A prospective study of pediatric loss of control eating and psychological outcomes. J Abnorm Psychol 120(1):108–118. https://doi.org/10.1037/a0021406
Taylor CB, Fitzsimmons-Craft EE, Graham AK (2020) Digital technology can revolutionize mental health services delivery: the COVID -19 crisis as a catalyst for change. Int J Eat Disord 53(7):1155–1157. https://doi.org/10.1002/eat.23300
Thompson-Brenner H, Westen D (2005) A naturalistic study of psychotherapy for bulimia nervosa, part 1: comorbidity and therapeutic outcome. J Nerv Ment Dis 193(9):573–584. https://doi.org/10.1097/01.nmd.0000178843.81100.eb
Timko CA et al (2015) An open trial of acceptance-based separated family treatment (ASFT) for adolescents with anorexia nervosa. Behav Res Ther 69:63–74. https://doi.org/10.1016/j.brat.2015.03.011
Treasure J, Stein D, Maguire S (2015) Has the time come for a staging model to map the course of eating disorders from high risk to severe enduring illness? An examination of the evidence: a staging model for eating disorders. Early Interv Psychiatry 9(3):173–184. https://doi.org/10.1111/eip.12170
Udo T, Grilo CM (2019) Psychiatric and medical correlates of DSM-5 eating disorders in a nationally representative sample of adults in the United States. Int J Eat Disord 52(1):42–50. https://doi.org/10.1002/eat.23004
Van Alsten SC, Duncan AE (2020) Lifetime patterns of comorbidity in eating disorders: an approach using sequence analysis. Eur Eat Disord Rev 28(6):709–723. https://doi.org/10.1002/erv.2767
Wilfley DE et al (2002) A randomized comparison of group cognitive-behavioral therapy and group interpersonal psychotherapy for the treatment of overweight individuals with binge-eating disorder. Arch Gen Psychiatry 59(8):713. https://doi.org/10.1001/archpsyc.59.8.713
Wisniewski L, Kelly E (2003) The application of dialectical behavior therapy to the treatment of eating disorders. Cogn Behav Pract 10(2):131–138. https://doi.org/10.1016/S1077-7229(03)80021-4
Wonderlich SA et al (2014) A randomized controlled comparison of integrative cognitive-affective therapy (ICAT) and enhanced cognitive-behavioral therapy (CBT-E) for bulimia nervosa. Psychol Med 44(3):543–553. https://doi.org/10.1017/S0033291713001098
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2022 Springer Nature Switzerland AG
About this entry
Cite this entry
Gorrell, S., Brosof, L., Hail, L., Le Grange, D. (2022). Treating Adolescent Bulimia Nervosa. In: Patel, V., Preedy, V. (eds) Eating Disorders. Springer, Cham. https://doi.org/10.1007/978-3-030-67929-3_47-1
Download citation
DOI: https://doi.org/10.1007/978-3-030-67929-3_47-1
Received:
Accepted:
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-67929-3
Online ISBN: 978-3-030-67929-3
eBook Packages: Springer Reference MedicineReference Module Medicine