Interrupting the binge-purge cycle in bulimia: the use of planned binges.

OBJECTIVE

To describe the rationale and use of a new procedure aimed at bringing binge/purge behavior directly under therapeutic control via the use of planned binges.

METHOD: Research investigating the specific effects of the various cognitive and behavioral components of the standard cognitive-behavioral treatment (CBT) approach for bulimia nervosa is examined in combination with comprehensive reviews of the treatment outcome literature.

RESULTS

These reviews suggest that while treatment has largely been effective at reducing binge-purge frequencies, it does not result in the elimination of the presenting problem for a significant proportion of participants. Evidence is presented to suggest that this may be accounted for by cognitive-behavioral approaches employing indirect procedures to bring the disordered patterns of eating under control. The application of the planned binge approach is illustrated by two cases treated at the University of New South Wales Post Graduate Psychology Clinic.

DISCUSSION: These cases in combination with the analysis of the potential deficits of the standard behavioral procedures employed in CBT provide tentative support for the use of planned binges as an addition to the strategies currently used in the treatment of binge and purge behavior. In conclusion the paper explores some of the ethical implications raised by asking subjects to engage in their problematic behavior.