| At one time, cognitive-behavioral therapy was | | | | percent were in partial remission, and 46.8 |
| considered to be the gold standard in the | | | | percent were in complete remission. |
| treatment of bulimia and binge eating disorder. In | | | | Five short-term studies in which patients were |
| 1993, Stuart Agras, a prominent researcher from | | | | followed for a year or more after treatment |
| Stanford University, investigated the current | | | | found that most patients do well at one year |
| treatment of binge eating, posing two complex | | | | after treatment with at least 75 percent showing |
| questions. The first was whether some | | | | no bulimic symptoms. In six studies where |
| treatments were better than others or whether | | | | patients have been followed for up to two years |
| all treatments were equally effective. The second | | | | or more, about one-half of the patients were in |
| question was whether treatments provided | | | | remission at follow-up. It was concluded that 50 |
| specific or nonspecific effects and whether they | | | | percent of bulimia nervosa patients were |
| worked by the same or different processes. | | | | symptom free two to ten years after intake, |
| Agras emphasized the importance of learning | | | | that about 20 percent of patients remained |
| which factors maintain binge eating and in which | | | | persistently symptomatic, and that the remainder |
| way a specific therapy influenced these factors. | | | | (about 30 percent) have a course of illness |
| He discussed the variation in assessment methods | | | | characterized by remissions and relapses or by |
| that made comparisons between and across | | | | persistent bulimic behavior that does not meet |
| studies extremely difficult. He found that studies | | | | clinical definition. |
| differed in diagnostic criteria, outcome criteria, and | | | | In 1997, Fichter and Quadflieg, a pair of German |
| length of follow-up intervals. Agras (1993) found | | | | researchers who are two of the best in the field, |
| that only 32 patients out of every 100 entering | | | | published the results of their 6-year long-term |
| treatment emerged eating disorder free 1 year or | | | | study of bulimia nervosa. They studied a group of |
| later. | | | | 196 female patients who fulfilled the diagnostic |
| Researchers performed a 2- to 9-year follow-up | | | | criteria according to the DSM-IV for bulimia |
| study on 52 women with the diagnosis of bulimia | | | | nervosa. The treatment they received focused |
| nervosa according to the DSM-III-R. The patients | | | | on biological, social, and psychological perspectives. |
| were treated in an inpatient eating disorders unit | | | | They assessed the patients pre-treatment, |
| at a university hospital, using behavioral methods | | | | post-treatment, at 2-year follow-up and at 6-year |
| to address eating behaviors, individual | | | | follow-up. Treatment lasted for 95.5 +/- 43 days; |
| psychotherapy, pharmacotherapy (if indicated), | | | | upon admission, patients ranged 25.6 +/- 6.7 |
| group therapy, and family therapy. Of the 52 | | | | years of age; and patients had had bulimia |
| women, 46 women were interviewed, 1 had died, | | | | nervosa for 8.1 +/- 4.9 years. At treatment |
| and 5 could not be located. Of the 46 inpatient | | | | discharge, 47 patients (24.1 percent) were |
| bulimic women, 39 percent had fully recovered | | | | significantly improved, 77 (39.5 percent) were |
| and 41 percent were still symptomatic. The longer | | | | markedly improved, 60 (30.8 percent) were |
| period of time after discharge, the greater | | | | slightly improved, and nine (4.6 percent) were |
| percentage of patients recovered. At the end of | | | | unchanged, one patient (0.5 percent) was |
| year one, 15 percent had recovered versus 67 | | | | somewhat worse, and another one (0.5 percent) |
| percent at the end of year 8. They found that | | | | as decidedly worse. |
| the mean duration of recovery was more than | | | | Fichter and Quadfliegs data show that patients |
| two years. | | | | substantially improve during inpatient treatment, |
| Another group in 1999 found the same results as | | | | show a slight decline during the next 2 years and |
| the previous group in that the number of women | | | | show further improvement until the last |
| who were symptomatic for bulimia nervosa | | | | assessment at 6 years. They state that the |
| declined as the length of time post-treatment | | | | longer the follow-up time, the number of |
| increases. Researchers strictly defined eating | | | | recovered patients increases and mortality |
| disorder outcome with both narrow and broad | | | | increases (6-year mortality for bulimia nervosa is |
| definitions. The narrow definition required a | | | | 1.1 percent). |
| subject to be free of bulimic symptomotology for | | | | The 6-year outcome study based on the |
| a period of six months, and in addition, for the | | | | presence or absence of a clinical eating disorder |
| subject not to use body weight and shape as a | | | | showed a relatively favorable course in the |
| way of judging herself. The broad definition | | | | treatment of bulimia nervosa. This study counted |
| required the subject to be free of disordered | | | | only the presence or absence of a full clinical |
| eating behaviors for at least eight weeks with no | | | | diagnosis so it missed some of the sub-syndromal |
| restrictions on self-evaluation of perceived weight | | | | behaviors. The researchers presented the |
| and shape. | | | | multidimensional data at four distinct points of |
| Women who had not met criteria for full | | | | time. The study showed that 59.9 percent of |
| remission but who no longer met DSM-IV criteria | | | | women participating in the study had a good |
| were considered to be in partial remission. The | | | | outcome, 29.4 percent an intermediate outcome, |
| researchers had a group of 173 women, with a | | | | 9.6 percent a poor outcome, and 1.1 percent |
| mean duration of follow-up of 11.5 +/- 1.9 years. | | | | were deceased. However, of the 133 females |
| This is the longest follow-up period in the English | | | | with no DSM-IV eating disorder at 6 year |
| language literature on bulimia nervosa with the | | | | follow-up, 25 still showed marked symptoms, 26 |
| second largest sample size. At follow-up, one | | | | had experienced no partial remission (or were |
| patient (0.6 percent) met full diagnostic criteria for | | | | unchanged), 45 showed residual symptoms, and |
| anorexia nervosa and 19 women (11 percent) met | | | | 37 were rated as usual self (or were eating |
| clinical diagnostic criteria for bulimia nervosa. | | | | disorder free). |
| Thirty-two women (18.5 percent) met the criteria | | | | It is interesting to note that the above outcome |
| for ED NOS, including one woman with Binge | | | | studies do not remark upon what the clients were |
| Eating Disorder. When researchers reported the | | | | doing all of these years. Were they in outpatient |
| results according to the narrow definition of | | | | treatment? Were they in individual psychotherapy |
| remission, they found that 28.3 percent of the | | | | for part of the time? Did they outgrow the |
| women were in partial remission at follow-up and | | | | disorder, indicating a maturation effect? More |
| 41.6 percent were in full remission. When they | | | | complete outcome studies are needed to further |
| reported the results according to the broad | | | | refine outcome research. |
| definition of remission, they found that 23.1 | | | | |