Hostname: page-component-cd9895bd7-jkksz Total loading time: 0 Render date: 2024-12-24T18:37:10.689Z Has data issue: false hasContentIssue false
  • English
  • Français

A Comparison of Nutritional Management with Stress Management in the Treatment of Bulimia Nervosa

Published online by Cambridge University Press:  02 January 2018

R. G. Laessle ,
P. J. V. Beumont ,
P. Butow ,
W. Lennerts ,
M. O'Connor ,
K. M. Pirke ,
S. W. Touyz  and
S. Waadt
R. G. Laessle*
Affiliation:
Max Planck Institute for Psychiatry, Munich
P. J. V. Beumont
Affiliation:
Department of Psychiatry, University of Sydney, Australia
P. Butow
Affiliation:
Department of Psychiatry, University of Sydney
W. Lennerts
Affiliation:
Max Planck Institute for Psychiatry, Munich
M. O'Connor
Affiliation:
Department of Psychiatry, Royal Prince Alfred Hospital, Sydney
K. M. Pirke
Affiliation:
Department of Clinical Chemistry and Division of Psychoneuroendocrinology, Max Planck Institute for Psychiatry, Munich
S. W. Touyz
Affiliation:
Department of Clinical Psychology, Westmead Hospital, Sydney
S. Waadt
Affiliation:
Max Planck Institute for Psychiatry, Munich
*
∗Department of Clinical Chemistry, Max Planck Institute for Psychiatry, Kraepelinstr. 10, 8000 Munich 40, Germany
Get access Rights & Permissions [Opens in a new window]

Abstract

In a comparison of nutritional management (NM) and stress management (SM) for treatment of bulimia nervosa, 55 female patients were randomly assigned to either treatment. Therapy consisted of 15 sessions in a group over three months, by the end of which, patients under both treatment conditions showed a significant reduction in the frequency of binge eating and vomiting and a significant improvement in various psychopathological features such as body dissatisfaction and depression. All improvements were maintained over 12–month follow-up. NM produced a more rapid improvement in general eating behaviour, a faster reduction in binge frequency and a higher abstinence rate from binge eating. SM led to greater positive changes in certain psychopathological features such as feelings of ineffectiveness, interpersonal distrust and anxiety. NM should be regarded as a necessary first intervention in all bulimic patients. Further psychological therapy, such as SM, is indicated as well for some patients, depending on their specific psychological difficulties.

Type
Papers
Information
The British Journal of Psychiatry , Volume 159 , Issue 2 , August 1991 , pp. 250 - 261
Copyright
Copyright © 1991 The Royal College of Psychiatrists 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abraham, S. F. & Beumont, P. I. V. (1982) How patients describe bulimia or binge eating. Psychological Medicine, 12, 625–635.CrossRefGoogle ScholarPubMed
Agras, W. S., Schneider, J. A., Arnow, B., et al (1989) Cognitive-behavioral and response prevention treatments for bulimia nervosa. Journal of Consulting and Clinical Psychology, 57, 215–221.CrossRefGoogle ScholarPubMed
American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders (3rd edn, revised) (DSM–III–R). Washington, DC: APA.Google Scholar
Beck, A. T. (1967) Depression. Clinical, Experimental and Theoretical Aspects. New York: Harper & Row.Google Scholar
Beck, A. T., Ward, C. H., Mendelson, M., et al (1961) An inventory for measuring depression. Archives of General Psychiatry, 4, 561–571.CrossRefGoogle ScholarPubMed
Beck, A. T., Rush, A. J., Shaw, B. F., et al (1979) Cognitive Therapy of Depression. Chichester: Wiley & Sons.Google Scholar
Bruch, H. (1978) The Golden Cage. New York: Open Books.Google Scholar
Cooper, P. J., Cooper, Z. & Hill, C. (1989) Behavioral treatment of bulimia nervosa. International Journal of Eating Disorders, 8, 87–92.3.0.CO;2-U>CrossRefGoogle Scholar
D'Zurilla, T. (1986) Problem-Solving Therapy: A Social Competence Approach to Clinical Intervention. New York: Springer.Google Scholar
Fairburn, C. G. (1985) Cognitive-behavioral treatment for bulimia. In Handbook of Psychotherapy for Anorexia Nervosa and Bulimia (eds Garner, D. M. & Garfinkel, P. E.). New York: Guilford Press.Google Scholar
Fairburn, C. G. & Cooper, P. J. (1982) Self-induced vomiting and bulimia nervosa: an undetected problem. British Medical Journal, 284, 1153–1155.CrossRefGoogle ScholarPubMed
Fairburn, C. G. & Cooper, P. J. (1984) The clinical features of bulimia nervosa. British Journal of Psychiatry, 144, 238–246.CrossRefGoogle ScholarPubMed
Fairburn, C. G., Kirk, J., O'Connor, M., et al (1986) A comparison of two psychological treatments for bulimia nervosa. Behavior Research and Therapy, 24, 629–643.Google ScholarPubMed
Fairburn, C. G., & Cooper, Z. (1987) Behavioural and cognitive approaches to the treatment of anorexia nervosa and bulimia nervosa. In Handbook of Eating Disorders, Part I: Anorexia and Bulimia nervosa. Amsterdam: Elsevier.Google Scholar
Fava, M., Copeland, P. M., Schweiger, U., et al (1989) Neurochemical abnormalities of anorexia nervosa and bulimia nervosa. American Journal of Psychiatry, 146, 963–971.Google ScholarPubMed
Feldhege, F. J. & Krauthan, G. (1978) Verhaltenstrainingsprogramm zium Aufbau sozialer Kompetenz. Berlin: Springer.Google Scholar
Fichter, M. M., Pirke, K. M., Pollinger, J., et al (1988) Restricted caloric intake causes neuroendocrine disturbances in bulimia. In The Psychobiology of Bulimia Nervosa (eds Pirke, K. M., Vandereycken, W. & Ploog, D.). Berlin: Springer.Google Scholar
Freeman, C. P. L., Barry, F., Dunkeld-Turnbull, J., et al (1988) Controlled trial of psychotherapy for bulimia nervosa. British Medical Journal, 296, 521–525.CrossRefGoogle ScholarPubMed
Garner, D. M. & Garfinkel, P. E. (1979) The eating attitudes test: an index of symptoms of anorexia nervosa. Psychological Medicine, 9, 273–279.CrossRefGoogle ScholarPubMed
Garner, D. M., Olmsted, M. P., Bohr, Y., et al (1982) The eating attitudes test: psychometric features and clinical correlates. Psychological Medicine, 12, 871–878.CrossRefGoogle ScholarPubMed
Garner, D. M., Olmsted, M. P., & Polivy, J. (1983) Development and validation of a multidimensional eating disorder inventory for anorexia nervosa and bulimia. International Journal of Eating Disorders, 2, 15–35.3.0.CO;2-6>CrossRefGoogle Scholar
Garner, D. M., Fairburn, C. G. & Davis, R. (1987) Cognitive-behavioral treatment of bulimia nervosa. Behavior Modification, 11, 398–431.CrossRefGoogle ScholarPubMed
Gwirtsman, H. E., Kaye, W. H., George, D. T., et al (1989) Hyperamylasemia and its relationship to binge-purge episodes: development of a clinically relevant laboratory test. Journal of Clinical Psychiatry, 50, 196–204.Google ScholarPubMed
Hawkins, R. C. & Clement, P. F. (1984) Binge eating syndrome: the measurement problem and a conceptual model. In Binge Eating: Theory, Research, and Treatment (eds Hawkins, R. C., Fremouw, W. & Clement, P. F.). New York: Springer.Google Scholar
Herman, C. P. & Polivy, J. (1988) Studies of eating in normal dieters. In Eating Behavior in Eating Disorders (ed. Walsh, B. T.). Washington, DC: American Psychiatric Association.Google Scholar
Kazdin, A. E. & Wilson, G. T. (1978) Criteria for evaluating psychotherapy. Archives of General Psychiatry, 35, 407–416.CrossRefGoogle ScholarPubMed
Keys, A., Brozek, J., Henschel, A., et al (1950) The Biology of Human Starvation. Minneapolis: University of Minnesota Press.CrossRefGoogle Scholar
Kirk, R. E. (1982) Experimental Design: Procedures for the Behavioural Sciences. Belmont, CA: Brooks-Cole.Google Scholar
Kirkley, B. G., Burge, J. C. & Ammerman, A. (1988) Dietary restraint, binge eating, and dietary behavior patterns. International Journal of Eating Disorders, 7, 771–778.3.0.CO;2-F>CrossRefGoogle Scholar
Kluthe, R. (1987) Praxisorientiertes Dialogsystem für Ernährung und Diätberatung (Dialogsystem for nutritional analysis; Computer Program). Stuttgart, F.R.G.: Wissenschaftliche Verlagsgesellschaft.Google Scholar
Lacey, J. H. (1983) Bulimia nervosa, binge eating, and psychogenic vomiting: a controlled treatment study and long term outcome. British Medical Journal, 286, 1609–1613.CrossRefGoogle ScholarPubMed
Lee, N. F. & Rush, A. J. (1986) Cognitive-behavioral group therapy for bulimia. International Journal of Eating Disorders, 5, 599–615.3.0.CO;2-W>CrossRefGoogle Scholar
Leitenberg, H., Rosen, J. C., Gross, J., et al (1988) Exposure plus response prevention treatment of bulimia nervosa. Journal of Consulting and Clinical Psychology, 56, 535–541.CrossRefGoogle ScholarPubMed
Loro, A. D. & Orleans, C. S. (1981) Binge eating in obesity: preliminary findings and guidelines for behavioural analysis and treatment. Addictive Behaviors, 6, 155–166.CrossRefGoogle ScholarPubMed
Meichenbaum, D. (1985) Stress Inoculation Training. New York: Pergamon Press.Google Scholar
Mitchell, J. E., Pyle, R. L., Eckert, E. D., et al (1990) A comparison study of antidepressants and structured intensive group psychotherapy in the treatment of bulimia nervosa. Archives of General Psychiatry, 47, 149–157.CrossRefGoogle ScholarPubMed
O'Brian, R. G. & Kaiser, M. K. (1985) MANOVA method for analyzing repeated measures designs: an extensive primer. Psychological Bulletin, 97, 316–333.CrossRefGoogle Scholar
O'Connor, M., Touyz, S. & Beumont, P. (1988) Nutritional management and dietary counselling in bulimia nervosa: some preliminary observations. International Journal of Eating Disorders, 7, 657–662.3.0.CO;2-6>CrossRefGoogle Scholar
Ordman, A. M. & Kirschenbaum, D. S. (1985) Cognitive-behavioral therapy for bulimia: an initial outcome study. Journal of Consulting and Clinical Psychology, 53, 305–313.CrossRefGoogle ScholarPubMed
Paul, T. & Jacobi, C. (1986) Ein ambulantes verhaltenstherapeutisches Gruppenprogramm bei Bulimia nervosa. Psychotherapie, Medizinische Psychologic und Psychosomatik, 36, 232–239.Google ScholarPubMed
Pirke, K. M., Pahl, J., Schweiger, U., et al (1985) Metabolic and endocrine indices of starvation in bulimia: a comparison with anorexia nervosa. Psychiatry Research, 15, 33–39.CrossRefGoogle ScholarPubMed
Pirke, K. M., Tuschl, R. J., Spyra, B., et al (1990) Endocrine findings in restrained eaters. Physiology and Behavior, 47, 359–364.CrossRefGoogle ScholarPubMed
Polivy, J. & Herman, C. P. (1985) Exposure plus response prevention treatment of bulimia. In Handbook of Psychotherapy for Anorexia Nervosa and Bulimia (ed. Garner, D. M. & Garfinkel, P. E.). New York: Guilford Press.Google Scholar
Rossiter, E. M., Agras, W. S., Losch, M., et al (1988) Dietary restraint of bulimic subjects following cognitive-behavioral or pharmacological treatment. Behavior Research and Therapy, 26, 495–498.CrossRefGoogle ScholarPubMed
Russell, G. F. M. (1979) Bulimia nervosa: an ominous variant of anorexia nervosa. Psychological Medicine, 9, 429–448.CrossRefGoogle ScholarPubMed
Schweiger, U., Laessle, R. G., Fichter, M. M., et al (1988) Consequences of dieting at normal weight: implications for the understanding and treatment of bulimia. In The Psychobiology of Bulimia Nervosa (eds Pirke, K. M., Vandereycken, W. & Ploog, D.). Berlin: Springer.Google Scholar
Souci, S. W., Fachmann, W. & Kraut, H. (1986) Food Composition and Nutrition Tables 1986/87. Stuttgart: Wissenschaftliche Verlagsgesellschaft.Google Scholar
Spielberger, C. D., Gorsuch, R. L. & Lushene, R. E. (1970) Manual for the State-Trait-Anxiety Inventory. Palo Alto, California: Consulting Psychologists Press.Google Scholar
Wilson, G. F., Rossiter, E., Kleifield, E. F., et al (1986) Cognitive-behavioral treatment of bulimia nervosa: A controlled evaluation. Behavior Research and Therapy, 24, 277–288.CrossRefGoogle ScholarPubMed
Woell, C., Fichter, M. M., Pirke, K. M., et al (1989) Eating behavior of patients with bulimia nervosa. International Journal of Eating Disorders, 8, 557–568.3.0.CO;2-8>CrossRefGoogle Scholar
Submit a response

eLetters

No eLetters have been published for this article.