CPG for Eating Disorders

Evidence indicates that it is unlikely to be a significant difference between CBT-BEDand IPT-BED in depression scores by the end of treatment (2 RCTs; N=194; Wilfley,1993 235 y 2002 249 ; DME; 0,22; 95% CI: -0,06 a 0,50) and at post-treatment follow-up (1RCT; N=138; Wilfley, 2002 249 ; SMD:0.10; 95% CI: -0.24 to 0.43).Evidence indicates that it is unlikely to be a significant difference between CBT-BEDand IPT-BED in psychosocial / interpersonal functioning by the end of treatment (2RCTs: N=194; Wilfley, 1993 235 and 2002 249 ; SMD: 0.06; 95% CI: -0.22 to 0.35).Evidence indicates that it is unlikely to be a significant difference between CBT-BEDand IPT-BED in depression scores at post-treatment follow-up (1 RCT, Wilfley,2002 249 : N=138; SMD: 0.13; 95% CI:-0.20 to 0.47).Evidence indicates that it is unlikely to be significant differences between CBT-BEDand BWC in depression scores by the end of treatment (SMD:-0.31; 95% CI:, -0.97 to0.34) and at follow-up (SMD: 0.21; 95% CI: -0.45 to 0.86) (1 RCT; N=37, Nauta,2000) 250 .RCT1++RCT1++RCT1++RCT1++Other resultsIn an RCT (Gorin, 2003; USA) 251 group CBT was compared to CBT with partnerinvolvement and wait-list, in a group of 94 adult women with BED under outpatienttreatment over 12 months. Compared to the control subjects, both groups significantlyreduced binge-eating and BMI, and improved psychological results such asdisinhibition, depression and self-esteem. The partner’s involvement in therapy did notproduce significant improvement compared to normal CBT. Both group therapies havesignificantly reduced depression scores compared to the control group, but there are nodifferences between them. Average BMI decrease from baseline to follow-up was 0.11for CBT and 0.77 for CBT-partner. This suggests that CBT alone does not produce asignificant change in BMI.In an RCT (Hilbert, 2004; Germany) 252 CBT-body exposure component was comparedto CBT-cognitive interventions for image disturbance in 28 adult women with BEDunder outpatient treatment with at least one binge-eating episode per week for 4months. Treatment duration was 5 months. Both groups decreased binge-eating anddepression scores but there were no significant differences between them.In a recent RCT (Schmith, 2007; UK) 238 FT was compared (N=31 BN, N=10 EDNOS)with CBT-GSH (N=30 BN, N=14 EDNOS) in adolescents between the ages of 13 and 20years, with BN or EDNOS. Treatment was administered over 6 months with 12-monthfollow-up. CBT-GSH was more effective at reducing binge-eating at 6 months than FT(p=0.03) even though this difference disappeared at 12 months. There were nodifferences between groups in terms of BMI, diet, eating fast and other attitudinal eatingdisorder symptoms. The direct cost of treatment was lower for CBT-GSH and noRCT1+RCT1+RCT1++109CLINICAL PRACTICE GUIDELINE FOR EATING DISORDERS