Integrated psychodynamic therapy for bulimia nervosa and binge eating disorder: theory, practice and preliminary findings

Abstract

While there is a substantial evidence base for the use of more recently developed therapeutic approaches, there is very little evidence that psychodynamically based treatments are effective in treating bulimia nervosa or binge-eating disorder. Clinicians have suggested that such an approach should be supplemented with behavioural foci and that it should be time-limited. This paper outlines an integrative approach to the outpatient treatment of these eating disorders, where psychodynamic principles and practice are used in tandem with behavioural strategies, and presents preliminary data on behavioural changes among patients who undertake this programme. A case series design was used, employing this approach with a selected group of 21 female patients. Data are presented on failure to complete the programme, as well as changes in body mass index and frequency of bingeing and vomiting. All of the 21 patients completed the programme, though 5 were lost to the study by the last follow-up point. Those who completed the programme had a stable body mass index, but showed clinically and statistically significant reductions in bulimic symptoms. These preliminary findings indicate that the bulimic disorders can be treated effectively using a psychodynamic approach that is integrated with behavioural techniques and that has time limits. While further research is needed to support this conclusion, it appears to be important to use a more integrative psychodynamic approach than is commonly used. Copyright © 2005 John Wiley & Sons, Ltd and Eating Disorders Association.