Psychological treatment of bulimia nervosa and binge eating disorder.

The field of eating disorders has grown rapidly, amassing an impressive body of treatment research in the past 20 years. In particular, researchers have focused on binge eating problems, which include bulimia nervosa (BN) and the more recently recognized binge eating disorder (BED). Numerous controlled treatment trials have shown cognitive-behavioral therapy (CBT) to be equally or more efficacious than any other BN treatment to which it has been compared. Although CBT also seems to be effective for BED, research is in a preliminary stage. Further combinations and adaptations of treatments for BED are needed to address the additional problem of obesity in this population. Preliminary data suggest that behavioral weight control treatment for BED is effective in reducing binge eating, and it may have the added benefit of weight loss. Interpersonal psychotherapy (IPT), the combination of CBT and medication, and self-help manuals are promising treatment alternatives for both BN and BED. Future treatment trials should include longer-term followup periods and more consistent definitions of successful treatment outcome. In addition, further study is needed in the areas of treatment nonresponders, pre-treatment predictors, a stepped-care treatment model, and methods for a wider dissemination of validated treatments.