A Randomized Controlled Comparison of Family-Based Treatment and Supportive Psychotherapy for Adolescent Bulimia Nervosa

CONTEXT: Evidenced-based treatment trials for adolescents with bulimia nervosa are largely absent. OBJECTIVE: To evaluate the relative efficacy of family-based treatment (FBT) and supportive psychotherapy (SPT) for adolescents with bulimia nervosa. DESIGN: Randomized controlled trial. SETTING: The University of Chicago from April 1, 2001, through June 30, 2006. PARTICIPANTS: Eighty patients, aged 12 to 19 years, with a DSM-IV diagnosis of bulimia nervosa or a strict definition of partial bulimia nervosa. INTERVENTIONS: Twenty outpatient visits over 6 months of FBT or SPT. Participants were followed up at 6 months posttreatment. MAIN OUTCOME MEASURES: Abstinence from binge-and-purge episodes as measured by the Eating Disorder Examination. Secondary outcome measures were Eating Disorder Examination binge-and-purge frequency and Eating Disorder Examination subscale scores. RESULTS: Forty-one patients were assigned to FBT and 39 to SPT. Categorical outcomes at posttreatment demonstrated that significantly more patients receiving FBT (16 39%) were binge-and-purge abstinent compared with those receiving SPT (7 18%) (P = .049). Somewhat fewer patients were abstinent at the 6-month follow-up; however, the difference was statistically in favor of FBT vs SPT (12 patients 29% vs 4 patients 10%; P = .05). Secondary outcome assessment, based on random regression analysis, revealed main effects in favor of FBT on all measures of eating pathological features (P = .003 to P = .03 for all). CONCLUSIONS: Family-based treatment showed a clinical and statistical advantage over SPT at posttreatment and at 6-month follow-up. Reduction in core bulimic symptoms was also more immediate for patients receiving FBT vs SPT.