Table 4

Summary of treatments for bulimia nervosa in adolescents

Type of therapyBrief definitionEvidence
Cognitive behavioural therapy adapted for adolescents
CBT is a therapy focusing on the relationship between current thoughts, feelings and behaviours and when used in eating disorders, focuses on the function of the bulimia in the person's life. Used widely in adults, this therapy has been adapted for adolescents.FBT may be more effective in promoting abstinence from binge eating and purging than CBT-A early on but there are no statistically significant differences between the two treatments by 12 months FU.37
CBT-guided self-careA manual that focuses on the function of the bulimia in the persons’ life and increases self-monitoring of thoughts, feelings and behaviours. The patient works through the manual with the therapist.CBT-guided self-care showed a faster reduction in binging episodes and was more cost effective compared with family based therapy (FBT) but no differences were seen at 12 months.38
Enhanced cognitive behavioural therapy for eating disorders (CBT-E)A specific form of CBT modified to be suitable for all eating disorders.Good outcomes for adults. One study showed substantial improvements in eating disorder psychopathology at the end of treatment but no long term follow up data are available.29
Family-based therapy (FBT)Focuses on behavioural change and empowers parents to take charge until recovery begins.More effective than supportive therapy.39 Similar effectiveness to CBT-A and CBT-guided self-care.37 39 Choice between these may depend on availability of family and level of conflict, individual factors and preference and skill set of therapist.
Dialectical behavioural therapy (DBT) (Fischer):For individuals presenting with suicidal and self-harming behaviour as well as eating difficulties. Teaches regulation of strong emotions by learning about what triggers them and developing coping strategies.Can reduce self-harm and other impulsive behaviours as well as eating disordered behaviours.40
Integrated DBT and FBT (Murray)A programme integrating FBT and DBT.In a recent pilot study, improvements only seen in ED pathology and not emotional regulation.41