ABSTRACT
To date, adolescent bulimia nervosa (BN) has received markedly less empirical attention than adolescent anorexia nervosa, with only two controlled trials demonstrating modest rates of full symptom remission (Le Grange, Crosby, Rathouz, & Leventhal, 2007; Schmidt et al., 2007). Le Grange et al. (2007) found that family-based treatment for adolescent BN (FBT-BN) was more efficacious than supportive psychotherapy, while Schmidt et al. (2007) found that cognitive behavioral therapy (CBT) guided self-care resulted in slightly more rapid reduction of bingeing than family therapy. In essence, BN is a disorder of complex etiology, characterized by frequent episodes of binge eating and purging/compensatory behaviors, which affects approximately 1-3 percent of the American population (Hudson, Hiripi, Pope, & Kessler, 2007; Swanson, Crow, Le Grange, Swendsen, & Merikangas, 2011). Furthermore, alongside core binge/purge-type symptomatology, frequent comorbid complexities include medical and psychological disorders, and impaired psychosocial functioning (Wonderlich & Mitchell, 1997), which may run over a protracted and relapsing illness course (Steinhausen, 2002). In addition to bulimic symptoms, 40 percent of adolescents with eating disorders report self-harming, which co-occurs significantly with binging/purging (Crow, Swanson, Le Grange, Feig, & Merikangas, 2014; Peebles, Wilson, & Lock, 2011). Population-based samples illustrate that among adolescents with BN, 53 percent reported suicidal ideation (SI), 26 percent reported a current plan for suicide, 35 percent reported a previous suicide attempt, and 17 percent reported multiple suicide attempts (Crow et al., 2014). It is important to note that participants for the two controlled studies (Le Grange et al., 2007; Schmidt et al., 2007) were excluded for having acute suicidality, substance dependence, or psychosis, therefore limiting the conclusions that we are able to draw from the existing evidence base about patients with a more complex diagnostic presentation.
