Patients who do not respond

Cognitive-behaviour therapy for bulimia nervosa is far from being a panacea. As discussed in Chapter.4.1,0.2, only a half to two-thirds of those who complete treatment obtain a substantial and lasting benefit, the remainder responding either partially or not at all. About 15 per cent of patients drop out.

There are no evidence-based guidelines for the treatment of patients who do not respond to cognitive-behaviour therapy. There are various logical alternatives including adding an antidepressant drug (fluoxetine 60 mg being an appropriate choice (l9i) and switching to interpersonal psychotherapy (29 (see Chapter.6.3.3) since both are treatments for bulimia nervosa in their own right. Modifying cognitive-behaviour therapy is also an option. For example, components of the treatment may be intensified (for example, by adding exposure with response prevention procedures (12> or more emphasis on body image(17>) or cognitive-behaviour therapy may be broadened to address more general issues such as self-esteem, mood regulation, and interpersonal functioning.

Breaking Bulimia

Breaking Bulimia

We have all been there: turning to the refrigerator if feeling lonely or bored or indulging in seconds or thirds if strained. But if you suffer from bulimia, the from time to time urge to overeat is more like an obsession.

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