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Relapse Predictors of Patients With Bulimia Nervosa Who Achieved Abstinence Through Cognitive Behavioral Therapy
Katherine A. Halmi, MD;
W. Stewart Agras, MD;
James Mitchell, MD;
G. Terence Wilson, PhD;
Scott Crow, MD;
Susan W. Bryson, MA;
Helena Kraemer, PhD
Arch Gen Psychiatry. 2002;59:1105-1109.
Background Little information exists on relapse in patients with bulimia nervosa who responded with complete abstinence from binge eating and purging to cognitive behavioral therapy. Identification of relapse predictors may be useful to design effective early intervention strategies for relapse of susceptible patients with bulimia nervosa.
Methods This multisite study examined relapse in 48 patients with bulimia nervosa who had responded to cognitive behavioral therapy with complete abstinence from binge eating and purging. Structured interviews and questionnaires were used to assess patients before and after treatment and at 4 months after treatment.
Results Four months after treatment, 44% of the patients had relapsed. Those who relapsed had a higher level of preoccupation and ritualization of eating and less motivation for change, and had maintained abstinence for a shorter time during the treatment period.
Conclusions The predictors of relapse found in this study can be readily determined by clinicians. The effectiveness of early additional treatment interventions needs to be determined with well-designed studies of large samples.
From the Department of Psychiatry, Weill Medical College of Cornell University, White Plains, NY (Dr Halmi); Department of Psychiatry, Stanford University School of Medicine, Palo Alto, Calif (Drs Agras and Kraemer and Ms Bryson); Department of Neurosciences and the Neuropsychiatric Research Institute, University of North Dakota School of Medicine and Health Services, Fargo (Dr Mitchell); Department of Psychology, Rutgers University, Piscataway, NJ (Dr Wilson); and Department of Psychiatry, University of Minnesota School of Medicine, Minneapolis (Dr Crow).
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