Abstract
Onset of bulimia nervosa (BN) typically occurs in adolescence and is frequently accompanied by medical and psychiatric sequelae that may have detrimental effects on adolescent development. Potentially serious medical consequences and high comorbid rates of mood disorders and suicidality underscore the need for early recognition and effective treatments. Research among adolescents with BN has lagged behind that of adults, although evidence is accumulating to support the efficacy of family-based interventions and cognitive behavioral treatments that are adapted for use with adolescent populations. The aim of the current article is to provide an overview of recent research on epidemiology, risk factors, diagnostic issues, and treatment interventions focusing on adolescent BN, and to highlight areas for future research.
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Golden NH, Katzman DK, Kreipe RE, et al. Eating disorders in adolescents: position paper of the society for adolescent medicine. J Adolesc Health. 2003;33:496–503.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association; 2000.
•• Swanson SA, Crow SJ, Le Grange D, et al. Prevalence and correlates of eating disorders in adolescents: results from the national comorbidity survey replication adolescent supplement. Arch Gen Psychiatry. 2011;68:714–23. This article is the largest population-based study of the prevalence and correlates of disordered eating among adolescents.
• Bravender T, Bryant-Waugh R, Herzog D, et al. Classification of eating disturbance in children and adolescents: proposed changes for the DSM-5. Eur Eat Disord Rev. 2010;18:79–89. This paper is an overview of suggested changes to DSM-5 eating disorder diagnostic criteria.
Workgroup for Classification of Eating Disorders in Children and Adolescents (WCEDCA). Classification of child and adolescent eating disturbances. Int J Eat Disord. 2007;40:S117–22.
Eddy KT, Doyle AC, Hoste RR, et al. Eating disorder not otherwise specified in adolescents. J Am Acad Child Adolesc Psychiatr. 2008;47:56–164.
Loeb KL, Le Grange D, Hildebrandt T, et al. Eating disorders in youth: diagnostic variability and predictive validity. Int J Eat Disord. 2011;44:692–702.
Shomaker LB, Tanofsky-Kraff M, Elliott C, et al. Salience of loss of control for pediatric binge episodes: does size really matter? Int J Eat Disord. 2010;43:707–16.
Bryant-Waugh RJ, Cooper PJ, Taylor CL, Lask BD. The use of the eating disorder examination with children: a pilot study. Int J Eat Disord. 1996;19:391–7.
Wilson GT, Sysko R. Frequency of binge eating episodes in bulimia nervosa and binge eating disorder: diagnostic considerations. Int J Eat Disord. 2009;42:603–10.
Preti A, de Girolamo G, Vilagut G, et al. The epidemiology of eating disorders in six European countries: results of the EDEMeD-WMH project. J Psychiatr Res. 2009;43:1125–32.
Touchette E, Henegar A, Godart NT, et al. Subclinical eating disorders and their comorbidity with mood and anxiety disorders in adolescent girls. Psychiatry Res. 2011;185:185–92.
Ackard DM, Fulkerson JA, Neumark-Sztainer D. Stability of eating disorder diagnostic classifications in adolescents: five-year longitudinal findings from a population-based study. Eat Disord. 2011;19:308–22.
• Peebles R, Hardy KK, Wilson JL, Lock JD. Are diagnostic criteria for eating disorders markers of medical severity? Pediatrics. 2010;125:e1193–201. Subthreshold eating disorders were found to be associated with significant medical complications.
Fischer S, Le Grange D. Comorbidity and high-risk behaviors in treatment-seeking adolescents with bulimia nervosa. Int J Eat Disord. 2007;40:751–3.
Le Grange D, Loeb KL, Van Orman S, Jellar CC. Bulimia nervosa in adolescents: a disorder in evolution? Arch Pediatr Adolesc Med. 2004;158:478–82.
Stice E, Marti N, Shaw H, Jaconis M. An 8-year longitudinal study of the natural history of threshold, subthreshold, and partial eating disorders from a community sample of adolescents. J Abnorm Psychol. 2009;118:587–97.
Abebe DS, Lien L, von Soest T. The development of bulimic symptoms from adolescence to young adulthood in females and males: a population-based longitudinal cohort study. Int J Eat Disord. doi:10.1002/eat.20950.
Linville D, Stice E, Gau J, O’Neil M. Predictive effects of mother and peer influences on increases in adolescent eating disorder risk factors and symptoms: a 3-year longitudinal study. Int J Eat Disord. 2011;44:745–51.
Salafia EHG, Gondoli DM. A 4-year longitudinal investigation of the processes by which parents and peers influence the development of early adolescent girls’ bulimic symptoms. J Early Adolesc. 2011;31:390–414.
Thomas JG, Butryn ML, Stice E, Lowe MR. A prospective test of the relation between weight change and risk for bulimia nervosa. Int J Eat Disord. 2011;44:295–303.
Day J, Schmidt U, Collier D, et al. Risk factors, correlates, and markers in early-onset bulimia nervosa and EDNOS. Int J Eat Disord. 2011;44:287–94.
Mata J, Gotlib IH. 5-HTTLPR moderates the relation between changes in depressive and bulimic symptoms in adolescent girls: a longitudinal study. Int J Eat Disord. 2011;44:383–8.
Katzman DK, Findlay SM. Medical issues unique to children and adolescents. In: Le Grange D, Lock J, editors. Eating disorders in children and adolescents: a clinical handbook. New York: Guilford Press; 2011. p. 137–55.
Rome ES, Ammerman S, Rosen DS, et al. Children and adolescents with eating disorders: the state of the art. Pediatrics. 2003;111:e98–e108.
Stiles-Shields EC, Smyth A, Glunz C, et al. A review of the role of psychiatrists and pediatricians in outpatient treatment of adolescents with anorexia and bulimia nervosa. Curr Psychiatr Rev. 2011;7:177–88.
Kotler LA, Cohen P, Davis M, et al. Longitudinal relationships between childhood, adolescent, and adult eating disorders. J Am Acad Child Adolesc Psychiatr. 2001;40:1424–40.
Kotler LA, Devlin MJ, Davies M, Walsh BT. An open trial of fluoxetine for adolescents with bulimia nervosa. J Child Adolesc Psychopharmacol. 2003;13:329–35.
Fluoxetine Bulimia Nervosa Collaborative Study Group. Fluoxetine in the treatment of bulimia nervosa: a multicenter, placebo-controlled, double-blind trial. Arch Gen Psychiatry. 1992;49:139–47.
• Le Grange D, Crosby RD, Rathouz PJ, Leventhal BL. A randomized controlled comparison of family-based treatment and supportive psychotherapy for adolescent bulimia nervosa. Arch Gen Psychiatry. 2007;64:1049–56. This is one of only two published RCTs of adolescents with bulimia nervosa. Family-based treatment was found to be more effective than individual supportive psychotherapy.
Le Grange D, Lock J. Treating bulimia in adolescents: a family-based approach. New York: Guilford Press; 2007.
Lock J, Le Grange D: Treatment manual for anorexia nervosa: a family-based approach. 2nd Edn. New York: Guilford Press; in press.
Le Grange D, Crosby RD, Lock J. Predictors and moderators of outcome in family-based treatment for adolescent bulimia nervosa. J Am Acad Child Adolesc Psychiatr. 2008;47:464–70.
Le Grange D, Doyle P, Crosby RD, Chen E. Early response to treatment in adolescent bulimia nervosa. Int J Eat Disord. 2008;41:755–7.
Lock J, Le Grange D, Crosby R. Exploring possible mechanisms of change in family-based treatment for adolescent bulimia nervosa. J Fam Ther. 2008;30:260–71.
Fisher M, Schneider M, Burns J, et al. Differences between adolescents and young adults at presentation to an eating disorders program. J Adolesc Health. 2001;28:222–7.
Perkins S, Schmidt U, Eisler I, et al. Why do adolescents with bulimia nervosa choose not to involve their parents in treatment? Eur Child Adolesc Psychiatr. 2005;14:376–85.
Zaitsoff SL, Doyle AC, Hoste RR, Le Grange D. How do adolescents with bulimia nervosa rate the acceptability and therapeutic relationship in family-based treatment? Int J Eat Disord. 2008;41:390–8.
Doyle AC, McLean C, Washington BN, et al. Are single-parent families different from two-parent families in the treatment of adolescent bulimia nervosa using family-based treatment? Int J Eat Disord. 2009;42:153–7.
Zabala MJ, Macdonald P, Treasure J. Appraisal of caregiving burden, expressed emotion and psychological distress in families of people with eating disorders: a systematic review. Eur Eat Disord Rev. 2009;17:338–49.
Winn S, Perkins S, Walwyn R, et al. Predictors of mental health problems and negative caregiving experiences in carers of adolescents with bulimia nervosa. Int J Eat Disord. 2007;40:171–8.
Hedlund S, Fichter MM, Quadflieg N, Brandl C. Expressed emotion, family environment, and parental bonding in bulimia nervosa: a 6-year investigation. Eat Weight Disord. 2003;8:26–35.
Hoste RR, Le Grange D. Expressed emotion among white and ethnic minority families of adolescents with bulimia nervosa. Eur Eat Disord Rev. 2008;16:395–400.
van Furth EF, van Strien DC, Martina LML, et al. Expressed emotion and the prediction of outcome in adolescent eating disorders. Int J Eat Disord. 1996;20:19–31.
Hoste RR, Hewell K, Le Grange D. Family interaction among white and ethnic minority adolescents with bulimia nervosa and their parents. Eur Eat Disord Rev. 2007;15:152–8.
Thomas S, Hoste RR, & Le Grange D. Observed connection and individuation: Relation to symptoms in families of adolescents with bulimia nervosa. International Journal of Eating Disorders. (in press).
• Schmidt U, Lee S, Beecham J, et al. A randomized controlled trial of family therapy and cognitive behavior therapy guided self-care for adolescents with bulimia nervosa and related disorders. Am J Psychiatry. 2007;164:591–598. This is one of only two published RCTs of adolescents with bulimia nervosa. Family therapy and cognitive behavior therapy—guided self-care were found to be equally effective, although CBT was more cost-efficient.
Agras WS, Walsh BT, Fairburn CG, et al. A multicenter comparison of cognitive-behavioral therapy and interpersonal psychotherapy for bulimia nervosa. Arch Gen Psychiatry. 2000;57:459–66.
Lock J. Adjusting cognitive behavior therapy for adolescents with bulimia nervosa: results of case series. Am J Psychother. 2005;59:267–81.
Schapman AM, Lock J, Couturier J. Cognitive-behavioral therapy for adolescents with binge eating syndromes: a case series. Int J Eat Disord. 2006;39:252–5.
Pretorius N, Arcelus J, Beecham J, et al. Cognitive-behavioural therapy for adolescents with bulimic symptomatology: the acceptability and effectiveness of internet-based delivery. Behav Res Ther. 2009;47:729–36.
Hewell K, Hoste RR, Le Grange D. Recruitment for an adolescent bulimia nervosa treatment study. Int J Eat Disord. 2006;39:594–7.
Hoste RR, Zaitsoff S, Hewell K, Le Grange D. What can dropouts teach us about retention in eating disorder treatment studies? Int J Eat Disord. 2007;40:668–71.
Halmi KA, Agras WS, Crow S, et al. Predictors of treatment acceptance and completion in anorexia nervosa: implications for future study designs. Arch Gen Psychiatry. 2005;62:776–81.
Lock J, Brandt H, Woodside B, et al. Challenges in conducting a multi-site randomized clinical trial comparing treatments for adolescent anorexia nervosa. Int J Eat Disord. 2012;45:202–13.
Disclosure
Dr Hoste has received research support from the National Eating Disorders Association, and has served as a consultant for the Training Institute for Child and Adolescent Eating Disorders.
Ms. Labuschagne is not funded by NIMH.
Dr Le Grange has received research support from NIMH, has received honoraria for conducting training workshops from the Training Institute for Child and Adolescent Eating Disorders, and has received royalties from Guilford Press.
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Hoste, R.R., Labuschagne, Z. & Le Grange, D. Adolescent Bulimia Nervosa. Curr Psychiatry Rep 14, 391–397 (2012). https://doi.org/10.1007/s11920-012-0280-0
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DOI: https://doi.org/10.1007/s11920-012-0280-0