A naturalistic study of psychotherapy for bulimia nervosa, part 2: therapeutic interventions in the community.

Data from naturalistic samples provide an important complement to findings from randomized trials of psychotherapy. A random national sample of US clinicians provided data on 145 completed treatments of patients with bulimic symptoms. We attempted to characterize the nature of treatments in the community and to examine the relation between treatment variables and outcome. Clinicians of all theoretical orientations report using interventions with polysymptomatic cases designed to address clinically significant personality characteristics and interpersonal patterns. Whereas cognitive-behavioral therapy is associated with more rapid remission of eating symptoms, psychodynamic interventions and increased treatment length predict better global outcome across treatment modalities, suggesting the importance of integrative treatments for the broad range of pathology seen in patients with bulimic symptoms.