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The British Journal of Psychiatry 159: 250-261 (1991)
© 1991 The Royal College of Psychiatrists

A comparison of nutritional management with stress management in the treatment of bulimia nervosa

RG Laessle, PJ Beumont, P Butow, W Lennerts, M O'Connor, KM Pirke, SW Touyz and S Waadt
Division of Psychoneuroendocrinology, Max Planck Institute for Psychiatry, Munich.

In a comparison of nutritional management (NM) and stress management (SM) for treatment of bulimia nervosa, 55 female patients were randomly assigned to either treatment. Therapy consisted of 15 sessions in a group over three months, by the end of which, patients under both treatment conditions showed a significant reduction in the frequency of binge eating and vomiting and a significant improvement in various psychopathological features such as body dissatisfaction and depression. All improvements were maintained over 12-month follow-up NM produced a more rapid improvement in general eating behaviour, a faster reduction in binge frequency and a higher abstinence rate from binge eating. SM led to greater positive changes in certain psychopathological features such as feelings of ineffectiveness, interpersonal distrust and anxiety. NM should be regarded as a necessary first intervention in all bulimic patients. Further psychological therapy, such as SM, is indicated as well for some patients, depending on their specific psychological difficulties.


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