An alternative intervention for Bulimia

Abstract

People with bulimia present with a variety of abnormal beliefs, attitudes, and behaviours. With few exceptions, studies to date have focused exclusively on the specific psychopathology of bulimia.

This controlled study of a brief group intervention did not directly address these behaviours. Based on a functional model of bulimia, the intervention aimed at expanding the subjects' repertoire of coping behaviours, and by cognitive restructuring, increase self-esteem and sense of wellbeing.

Twenty-four females (mean age= 31.97 years) who fulfilled the DSM-III criteria for bulimia, were recruited by newspaper advertisement Subjects were matched into groups of three on the basis of their score on a measure of bulimia (Bulit: Smith & Thelen, 1984) and randomly allocated to one of two intervention groups or a waiting-list control. Each intervention consisted of seven two-hour sessions at weekly intervals and an optional one-hour individual session. The group interventions differed in that mental imagery tasks were included for one group. All subjects completed the intervention.

Intervention groups showed significant improvement on measures of bulimia, depression, anxiety, wellbeing and self-esteem, three weeks after intervention with further improvement at 3-month and 3-year follow-up. The waiting-list control group showed significant improvement in depression and wellbeing. By 3-month follow-up, 10 subjects (62.5 % ) no longer scored in the bulimic range on the Bulit. At 3-year follow-up, only 4 subjects (25%) scored in the bulimic range. Of 8 subjects who reported regular Self-induced vomiting at pre-intervention, 6 (75%) were abstinent at 3-month follow-up and remained so at 3-year follow-up. The remaining 2 subjects reported a 75% reduction in their vomiting frequency. Outcome was not significantly correlated with age, subtype of bulimia, initial levels of anxiety, depression or self-esteem. While the duration of bulimic behaviours did not significantly correlate with outcome, the subjects' perceived duration of the eating disorder did show a significant correlation with outcome at post-intervention and 3-month follow-up.

Severity of bulimia was significantly different between the intervention groups at post-intervention and 3-month follow-up, but not at 3-year follow-up. Post-hoc comparison of these groups revealed a significant difference only in the perceived duration of the eating disorder.

The result of this study suggests that bulimic behaviours can be modified by an intervention which aims to expand the repertoire of coping and social skills rather than focusing on decreasing bulimic behaviours and cognitions.