Treatment of bulimia nervosa and binge eating disorder

Bulimia nervosa and binge eating disorder are complex eating disorders with a major impact on the life of the patient and that of their family. Over the past two decades, increasing prevalence and incidence rates have confronted primary care and mental health services with high demands for treatment for these disorders that are difficult to meet. Psychotherapeutic interventions are the first-choice treatment. Cognitive–behavioural therapy (CBT) is efficacious in both bulimia nervosa and binge eating disorder, but there is a need to improve outcomes further. Interpersonal psychotherapy (IPT) has also been shown to have benefits, although in bulimia nervosa the response has been slower than with CBT. In general, delivering psychotherapy is costly and is often hampered by limited availability. Self-help versions of CBT may help to overcome these difficulties. Although promising, further exploration is required as to whether self-help strategies are an alternative to or can reduce therapist involvement. Alternatively, pharmacotherapy is a potential treatment option for bulimia nervosa and binge eating disorder, with evidence predominantly on antidepressants. Fluoxetine in a higher dose has been recommended because it is relatively better tolerated than antidepressants of other classes. Overall, combined psychotherapy and pharmacotherapy in patients with bulimia nervosa produces somewhat better outcomes than pharmacotherapy alone, but is not clearly superior to psychotherapy alone. Data on combination treatment in binge eating disorder are less conclusive. Although the therapeutic arsenal for the treatment of bulimia nervosa and binge eating disorder is expanding, several domains required further investigation.