Hostname: page-component-5f56664f6-kch4j Total loading time: 0 Render date: 2025-05-07T18:56:08.925Z Has data issue: false hasContentIssue false
  • English
  • Français

Treatments for bulimia nervosa: a network meta-analysis

Published online by Cambridge University Press:  06 May 2018

Eric Slade ,
Edna Keeney ,
Ifigeneia Mavranezouli ,
Sofia Dias ,
Linyun Fou ,
Sarah Stockton ,
Leanne Saxon ,
Glenn Waller ,
Hannah Turner  and
Lucy Serpell
...Show all authors
Eric Slade*
Affiliation:
National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, 27 Sussex Place, London, NW1 4RG, UK
Edna Keeney
Affiliation:
University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
Ifigeneia Mavranezouli
Affiliation:
National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, 27 Sussex Place, London, NW1 4RG, UK Research Department of Clinical, Educational & Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
Sofia Dias
Affiliation:
University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
Linyun Fou
Affiliation:
National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, 27 Sussex Place, London, NW1 4RG, UK
Sarah Stockton
Affiliation:
National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, 27 Sussex Place, London, NW1 4RG, UK
Leanne Saxon
Affiliation:
National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, 27 Sussex Place, London, NW1 4RG, UK Research Department of Clinical, Educational & Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
Glenn Waller
Affiliation:
Department of Psychology, University of Sheffield, Floor D, Cathedral Court, 1 Vicar Lane, Sheffield, S1 2LT, UK
Hannah Turner
Affiliation:
Southern Health NHS Foundation Trust, April House, 9 Bath Road, Bitterne, Southampton, SO19 5ES, UK
Lucy Serpell
Affiliation:
University College London, 1-19 Torrington Place, London, WC1E 7HB, UK Eating Disorder Service, North East London Foundation NHS Trust, Porters Avenue Health Centre, 234 Porters Avenue, Dagenham, Essex RM8 2EQ, UK
Christopher G. Fairburn
Affiliation:
University of Oxford, Department of Psychiatry, Warneford Hospital, Oxford, OX3 7JX, UK
Tim Kendall
Affiliation:
National Collaborating Centre for Mental Health, Royal College of Psychiatrists, 21 Prescot St, Whitechapel, London E1 8BB, UK
*
Author for correspondence: Eric Slade, E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Bulimia nervosa (BN) is a severe eating disorder that can be managed using a variety of treatments including pharmacological, psychological, and combination treatments. We aimed to compare their effectiveness and to identify the most effective for the treatment of BN in adults.

Methods

A search was conducted in Embase, Medline, PsycINFO, and Central from their inception to July 2016. Studies were included if they reported on treatments for adults who fulfilled diagnostic criteria for BN. Only randomised controlled trials (RCTs) that examined available psychological, pharmacological, or combination therapies licensed in the UK were included. We conducted a network meta-analysis (NMA) of RCTs. The outcome analysed was full remission at the end of treatment.

Results

We identified 21 eligible trials with 1828 participants involving 12 treatments, including wait list. The results of the NMA suggested that individual cognitive behavioural therapy (CBT) (specific to eating disorders) was most effective in achieving remission at the end of treatment compared with wait list (OR 3.89, 95% CrI 1.19–14.02), followed by guided cognitive behavioural self-help (OR 3.81, 95% CrI 1.51–10.90). Inconsistency checks did not identify any significant inconsistency between the direct and indirect evidence.

Conclusions

The analysis suggested that the treatments that are most likely to achieve full remission are individual CBT (specific to eating disorders) and guided cognitive behavioural self-help, although no firm conclusions could be drawn due to the limited evidence base. There is a need for further research on the maintenance of treatment effects and the mediators of treatment outcome.

Keywords

Bulimia nervosaeating disorderNational Institute of Health and Care Excellencenetwork meta-analysisoutcome research
Type
Review Article
Information
Psychological Medicine , Volume 48 , Issue 16 , December 2018 , pp. 2629 - 2636
Copyright
Copyright © Cambridge University Press 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Agras, WS et al. (2000) A multicenter comparison of cognitive-behavioral therapy and interpersonal psychotherapy for bulimia nervosa. Archives of General Psychiatry 57, 459–466.Google Scholar
Bailer, U et al. (2004) Guided self-help versus cognitive-behavioral group therapy in the treatment of bulimia nervosa. International Journal of Eating Disorders 35, 522–537.Google Scholar
Balshem, H, Helfand, M and Schunemann, HJ (2011) GRADE guidelines: 3. Rating the quality of evidence. Journal of Clinial Epidemiology 64, 401–406.Google Scholar
Beintner, I, Jacobi, C and Schmidt, UH (2014) Participation and outcome in manualized self-help for bulimia nervosa and binge eating disorder – a systematic review and metaregression analysis. Clinical Psychology Review 34, 158–176.Google Scholar
Cooper, PJ and Fairburn, CG (1993) Confusion over the core psychopathology of bulimia nervosa. International Journal of Eating Disorders 13, 385–389.Google Scholar
Dempster, A (1997) The direct use of likelihood for significance testing. Statistics and Computing 7, 247–252.Google Scholar
Dias, S et al. (2011 a) NICE DSU Technical support document 2: a generalised linear modelling framework for pair-wise and network meta-analysis of randomised controlled trials (last updated 2016).Google Scholar
Dias, S et al. (2011 b) NICE DSU Technical support document 4: inconsistency in networks of evidence based on randomised controlled trials (last updated 2014).Google Scholar
Dias, S et al. (2013) Evidence synthesis for decision making 4: inconsistency in networks of evidence based on randomized controlled trials. Medical Decision Making 33, 641–656.Google Scholar
Fairburn, CG and Harrison, PJ (2003) Eating disorders. Lancet 361, 407–416.Google Scholar
Fairburn, CG et al. (1993) Psychotherapy and bulimia nervosa. Longer-term effects of interpersonal psychotherapy, behavior therapy, and cognitive behavior therapy. Archives of General Psychiatry 50, 419–428.Google Scholar
Fairburn, CG et al. (2015) A transdiagnostic comparison of enhanced cognitive behaviour therapy (CBT-E) and interpersonal psychotherapy in the treatment of eating disorders. Behaviour Research and Therapy 70, 64–71.Google Scholar
Guyatt, G et al. (2011) GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. Journal of Clinical Epidemiology 64, 383–394.Google Scholar
Hay, P (2013) A systematic review of evidence for psychological treatments in eating disorders: 2005–2012. International Journal of Eating Disorders 46, 462–469.Google Scholar
Linardon, J et al. (2017) The efficacy of cognitive-behavioral therapy for eating disorders: a systematic review and meta-analysis. Journal of Consulting and Clinical Psychology 85, 1080–1094.Google Scholar
Lunn, D et al. (2013) The BUGS Book. Boca Raton, FL: CRC Press.Google Scholar
Mavridis, D et al. (2015) A primer on network meta-analysis with emphasis on mental health. Evidence Based Mental Health 18, 40–46.Google Scholar
Moher, D et al. (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Journal of Clinical Epidemiology 62, 1006–1012.Google Scholar
NICE (2017) Eating Disorders: Recognition and Treatment. NICE Clinical Guideline 69. London: National Institute for Health and Care Excellence.Google Scholar
Peat, CM et al. (2017) Comparative effectiveness of treatments for binge-eating disorder: systematic review and network meta-analysis. European Eating Disorder Review 25, 317–328.Google Scholar
Polnay, A et al. (2014) Group therapy for people with bulimia nervosa: systematic review and meta-analysis. Psychological Medicine 44, 2241–2254.Google Scholar
Pope, JH et al. (1989) A placebo-controlled study of trazodone in bulimia nervosa. Journal of Clinical Psychopharmacology 9, 254–259.Google Scholar
Poulsen, S et al. (2014) A randomized controlled trial of psychoanalytic psychotherapy or cognitive-behavioral therapy for bulimia nervosa. American Journal of Psychiatry 171, 109–116.Google Scholar
Shapiro, JR et al. (2007) Bulimia nervosa treatment: a systematic review of randomized controlled trials. International Journal of Eating Disorders 40, 321–336.Google Scholar
Smink, FR, Van Hoeken, D and Hoek, HW (2013) Epidemiology, course, and outcome of eating disorders. Current Opinion in Psychiatry 26, 543–548.Google Scholar
Spiegelhalter, D et al. (2002) Bayesian measures of model complexity and fit. Journal of the Royal Statistical Society: Series B (Statistical Methodology) 64, 583–639.Google Scholar
Stice, E, Marti, CN and Rohde, P (2013) Prevalence, incidence, impairment, and course of the proposed DSM-5 eating disorder diagnoses in an 8-year prospective community study of young women. Journal of Abnormal Psychology 122, 445–457.Google Scholar
Sweeting, J et al. (2004) What to add to nothing? Use and avoidance of continuity corrections in meta-analysis of sparse data. Statistics in Medicine 23, 1351–1375.Google Scholar
Thompson-Brenner, H, Glass, S and Westen, D (2003) A multidimensional meta-analysis of psychotherapy for bulimia nervosa. Clinical Psychology: Science and Practice 10, 269–287.Google Scholar
Trace, SE et al. (2012) Effects of reducing the frequency and duration criteria for binge eating on lifetime prevalence of bulimia nervosa and binge eating disorder: implications for DSM-5. International Journal of Eating Disorders 45, 531–536.Google Scholar
Wagner, G et al. (2013) Internet-delivered cognitive-behavioural therapy v. conventional guided self-help for bulimia nervosa: long-term evaluation of a randomised controlled trial. British Journal of Psychiatry 202, 135–141.Google Scholar
Whittal, ML, Agras, WS and Gould, RA (2000) Bulimia nervosa: a meta-analysis of psychosocial and pharmacological treatments. Behaviour Therapy 30, 117–135.Google Scholar
Supplementary material: File

Slade et al. supplementary material 1

Slade et al. supplementary material

Download Slade et al. supplementary material 1(File)
File 168.1 KB