CPG for Eating Disorders

In an RCT (Wilson, 2002; USA) 234 CBT was compared to IPT in a sample of 20 adultwomen with BN under outpatient treatment for 6 weeks. In this study, CBT-BN wassuperior than IPT in reducing dietary restraint at 6 weeks of treatment, improvingbinge-eating and purging at 10 weeks of treatment, and reducing binge-eating aftertreatment. CBT was more effective at reducing the frequency of vomiting at 6 weeksafter treatment than IPT.In an RCT (Wilfley, 1993; USA) 235 that compared group CBT with group IPT andwait-list, in 56 adult women with BN, CBT and IPT were superior to the control group(wait-list) in reducing frequency of binge-eating episodes, disinhibition and restraint at16 weeks of treatment. There were no significant differences between both grouptherapies.A further RCT (Bulik, 1998; New Zealand) 236 performed on 111 adult women withBN under outpatient treatment compared CBT (8 weeks) followed by ERP for bingeeating(G1) with CBT followed by ERP for vomit-inducing signs (G2) and with CBTfollowed by relaxation training (G3). G3 was superior to G1 in reducing depressivebehaviour and body dissatisfaction at the end of treatment and at 2-years follow-up.Relaxation was superior to G2 in reducing depressive behaviour and psychologicaleating disorder and behavioural attitudes at the end of treatment and at 3-years followup.An additional RCT (Sundgot-Borgen, 2002; Norway) 212 compared exercise with CBT,NC, wait-list and healthy control subjects in a group of 74 adult women with BN underoutpatient treatment. Exercise was superior to CBT in reducing binge-eating episodes,laxative abuse and the desire to be thin throughout 18 months of follow-up.An RCT (Bailer, 2004;Austria) 230 compared group CBT with group GSH in 81 adultwomen with BN under outpatient treatment. The GSH was administered bypsychiatrists in training. Both treatments significantly reduced binge-eating, vomiting,laxative abuse, the EDI questionnaire score, the desire to be thin and bodydissatisfaction. At one year follow-up, patients treat with GSH obtained greaterreduction in purging and EDI questionnaire score. CBT was associated with greaterreduction in the desire to be thin at the end of treatment and at follow-up. Boththerapies significantly improved depression at the end of treatment. At follow-up,individuals with GSH obtained better results in decreasing depression scores. Withinthe group of patients who completed treatment, there was a significant difference in thegroup treated with GSH in the maintenance of remission for more than 2 weeks (74%vs. 44%). There were no significant changes in weight in patients treated with GSH.In an RCT (Thiels, 1998;Alemania) 237 CBT was compared to GSH for 16 weeks in agroup of 62 adult women with BN under outpatient treatment. Treatment wasadministered by psychotherapists. In both treatments, a significant decrease in bingeeating,purging and BITE and EAT scores was reported. There were no significantdifferences among groups in terms of depression.In a recent RCT (Schmith, 2007; UK) 238 FT (N=31 BN, N=10 EDNOS) wascompared to CBT-GSH (N=30 BN, N=14 EDNOS) in adolescents aged between 13and 20 years. Treatment was administered for 6 months and follow-up was carried outthroughout 12 months. CBT-GSH reduced binge-eating more than FT at 6 months(p=0.03) although at 12 months the difference between them disappeared. There wereRCT1 +RCT1 +RCT1 ++RCT1 +RCT1 +RCT1 +RCT1 ++103CLINICAL PRACTICE GUIDELINE FOR EATING DISORDERS