A Cochrane review [Abstract] 1 included 48 studies with a total of 3 054 subjects (aged>16 years with bulimia nervosa, binge eating disorder and/or eating disorder not otherwise specified (EDNOS) of a bulimic type). The review supported the efficacy of cognitive behavioural therapy (CBT) and particularly CBT-BN (a specific manual-based form of cognitive behavioural therapy developed for the treatment of bulimia nervosa) in the treatment of people with bulimia nervosa and also, but less strongly due to the small number of trials, related eating disorder syndromes. Other psychotherapies were also efficacious, particularly interpersonal psychotherapy in the longer-term. Self-help approaches that used highly structured CBT treatment manuals were promising. Psychotherapy alone was unlikely to reduce or change body weight in people with bulimia nervosa or similar eating disorders.
Another systematic review 2 including 9 medication studies, 13 psychosocial studies, and 4 combination studies was abstracted in DARE. Both medication and cognitive-behavioural therapy were well tolerated and effective in the short term in reducing eating disorder symptomatology pre- to post-treatment (for medication, effect size for binge eating was 0.66, 95% CI 0.52 to 0.81), but psychosocial treatment was significantly more effective than medication in reducing self-reported binge (effect size 1.28, 95% CI 1.09 to 1.47) and purge frequency (effect size 1.22, 95% CI 1.06 to 1.39), depression (effect size 1.31, 95% CI 1.10 to 1.51), and self-reported eating attitudes. There is also a suggestion that combined medication and CBT treatment is superior to medication alone and may or may not be better than CBT alone.
Comment: The quality of evidence is downgraded by study quality (inadequate or unclear allocation concealment).
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