Bulimia nervosa: Treatment with exposure and response prevention

Abstract

Fear of weight gain, binging, and self-induced vomiting are the salient features of bulimia nervosa in normal weight individuals. An exposure plus vomiting response prevention procedure was evaluated in a multiple baseline design across three classes of food stimuli for a patient suffering from chronic bulimia nervosa. Amount of food consumed without vomiting increased and subjective discomfort after eating decreased when exposure plus response prevention treatment was sequentially applied to each class of food. Complete cessation of vomiting and binging and minimal discomfort were subsequently achieved during a postexperimental response prevention phase. Treatment effects were maintained at 10-month follow-up. The results suggest that binging in bulimia nervosa is more a consequence of vomiting than vomiting is a consequence of binging. They also support the hypothesis that vomiting in bulimia nervosa is an escape-avoidance response reinforced by anxiety reduction, similar in function to compulsive hand washing and checking rituals in obsessive-compulsive neuroses.