DClinPsy Portfolio Volume 1 of 3 - University of Hertfordshire ...

The leading alternative treatment is thought to be Interpersonal Psychotherapy (IPT)
which, in statistical terms, is comparable in its eventual effects but much slower to act
(Agras, Walsh, Fairburn, Wilson & Kraemer, 2000b). Evidence suggests that the most
powerful and consistent predictors of prognosis are the frequency of binge eating and
purging at the start of treatment (the higher the frequency, the worse the prognosis) and,
most importantly, the extent of their reduction over the initial weeks of treatment (Agras
et al., 2000a). The predictive utility of early response to CBT is not confined to BN but
has been reported in other disorders including depression, alcohol abuse and obesity.
Despite the promising findings, Fairburn, et al (2003) admits that CBT-BN is not
effective enough, as at best, only half the patients make a full and lasting response. This
raises the important question “Why aren’t more people getting better?”
The lack of greater effectiveness in eating disorder treatment generally may indicate that
CBT for eating disorders may need to become broader in its scope. The commonalities
between the eating disorders are apparent when they are viewed longitudinally even more
so than cross-sectionally. For example in patients who do not recover from AN, a crossover
to BN often occurs (e.g., Sullivan, Bulik, Fear, & Pickering, 1998), the result being
that about a quarter of patients with BN have had AN in the past (e.g., Agras, Walsh,
Fairburn, Wilson & Kraemer, 2000b). This may suggest that there are fundamental
processes that are not being focused on in current treatment approaches that are common
to different eating disorders/problems.
Fairburn et al (2003) point out that the significance of the migration of patients across the
diagnostic categories of AN, BN and the atypical eating disorders has received little
attention even though this cross over may not be random. Age and/or duration of disorder
were put forward as relevant, with eating disorders of mid-adolescence typically taking
the form of anorexia nervosa or an anorexia nervosa-like state, whereas a bulimia
nervosa-like picture is more typical of those of late adolescence or early adulthood.
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