A very substantial number of well-designed studies (Type 1 and Type 2) have shown that manual-based cognitive-behavioral therapy (CBT) is currently the treatment of choice for bulimia nervosa (BN); roughly half of patients receiving CBT cease binge eating and purging. Well accepted by patients, CBT is the most effective means of eliminating the core features of the eating disorder and is often accompanied by improvement in psychological problems such as low self-esteem and depression; long-term maintenance of improvement is reasonably good. A large number of good to excellent outcome studies (Type 1 and Type 2) suggest that different classes of antidepressant drugs produce significantly greater reductions in the short term for binge eating and purging in BN patients than a placebo treatment; the long-term effects of antidepressant medication on BN remain untested. There is little evidence that combining CBT with antidepressant medication significantly enhances improvement in the core features of BN, although it may aid in treating comorbid anxiety and depression. The continuing paucity of controlled research on outcomes of treatment for anorexia nervosa (AN) contrasts sharply with the quantity and quality of research on outcomes of treatment for BN and binge-eating disorder (BED). Nevertheless, a specific form of family therapy, referred to as the Maudsley Model, has shown promising effects on AN in adolescent patients, although this remains to be shown to be a specific effect. Several different psychological treatments appear equally effective in reducing the frequency of binge eating in the short term in BED; these treatments include CBT, interpersonal therapy (IPT), behavioral weight loss programs, and guided self-help based on cognitive-behavioral principles. To date, only CBT and IPT have been shown to have significant longer term effects in eliminating binge eating. Evidence on the specific effects of antidepressant medication on BED is mixed. As yet, there has been no research on the treatment of the most common eating disorder diagnosis, “eating disorder not otherwise specified.”
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