CPG for Eating Disorders

elaborated by the AHRQ of the US (2006) 31 and on a more recently published one (Shapiro, etal., 2007) 211 . The updated search has not identified any new evidence on the safety of BT in BN.Variables: reduction / remission of binge-eating and purgingIt is not likely that CBT-BN is more effective than BT in reducing the frequency ofbinge-eating (SMD: -0.11; 95% CI: -0.45 to 0.24) and purging (SMD: 0.08; 95% CI: -0.27 to 0.42) by the end of treatment, according to 3 RCTs (N=131; Fairburn, 1991 224 ;Freeman, 1988 220 ; Wolf, 1992 221 ).RCT1++Variables: depression and/or interpersonal and psychosocial functioningand/or general psychiatric symptomsThere is insufficient evidence to determine that CBT-BN differs from BT in terms ofgeneral psychiatric symptoms (1 RCT; N=33; Fairburn, 1991 224 ; SMD: -0.09; 95% CI:-0.79 to 0.61) and interpersonal and psychosocial functioning (1 RCT; N=32; Fairburn,1991 224 ; SMD: 0.14; 95% CI: -0.56 to 0.85) at follow-up.There is insufficient evidence to determine that CBT-BN differs from BT in thereduction of general psychiatric symptoms (SMD: -0.26; 95% CI: -0.89 to 0.37) and ininterpersonal and psychosocial functioning (SMD: -0.21; 95% CI: -0.84 to 0.42) by theend of treatment according to 1 RCT (N=39; Fairburn, 1991) 224 .There is insufficient evidence to determine that there are significant differences betweenBT and IPT in general psychiatric symptoms scores by the end of treatment (1 RCT;N=39; Fairburn, 1991 224 ; SMD: 0.09; 95% CI: -0.54 to 0.7) and at follow-up (1 RCT;N=31; Fairburn, 1991 224 ; SMD: 0.07; 95% CI: -0.65 to 0.78).There is insufficient evidence to determine that there are significant differences betweenBT and IPT in interpersonal and psychosocial functioning by the end of treatment (1RCT: N=39; Fairburn, 1991 224 ; SMD: -0.06; 95% CI: -0.69 to 0.55) and at follow-up (1RCT; N=31; Fairburn, 1991 224 ; SMD: -0.19; 95% CI: -0.91 to 0.52).In two RCTs (Fairburn, 1991; UK 224 and 1993 275 ) in 75 adult women with BN underoutpatient treatment, CBT was compared with BT and IPT. CBT was superior to BT at18 months of treatment in reducing symptoms related with diet, psychopathology andbody figure. CBT was more effective than IPT in reduction of vomiting. At 12-monthsfollow-up, CBT was superior to BT in abstinence of symptoms.RCT1++RCT1++RCT1++RCT1++RCT1+Summary of the Evidence(See also summary of the evidence for psychological treatment)SRSE 311++CBT is more effective than BT alone due to the cognitive component itincorporates, which seems to be the most important aspect. (Fairburn, 1991 224and 1993 275 ).132CLINICAL PRACTICE GUIDELINE FOR EATING DISORDERS