Testing an Alternative Therapy for Bulimia Nervosa

Bulimia nervosa (BN) is a disorder characterized by binge eating and compensatory behaviors,
such as self-induced vomiting or laxative abuse. It affects 1% to 2% of adolescents and young
women, and occurs more rarely in men. People who suffer from BN are also more likely to
suffer from other psychiatric disorders, such as anxiety disorders, mood disorders, substance
abuse disorders, and personality disorders—those categorized as Axis II in the DSM IV.

Integrative cognitive-affective therapy (ICAT) is a new treatment developed as an alternative
to cognitive behavioral therapy (CBT) for treating people with BN. CBT is the standard
treatment for BN. ICAT uses some elements from CBT and some elements from therapies used to
treat other disorders. Some elements of ICAT are also used to treat substance abuse
disorders, depression, and personality disorders. This study will compare the effectiveness
of ICAT and CBT in treating BN.

Participants in this study, who must have BN symptoms, will be randomly assigned to receive
either CBT or ICAT treatment. Participation in this study will last 18 weeks for participants
assigned to receive CBT and 16 weeks for participants assigned to receive ICAT. Both
treatments will consist of 20 individual therapy sessions lasting 50 minutes. Additionally,
participants receiving ICAT will receive personal digital assistant (PDA) devices installed
with therapeutic modules. Use of these modules will be unlimited during the period of ICAT
treatment and will be recorded at study visits. Over the course of 2 screening visits,
participants will complete questionnaires, undergo clinical interviews, and go through a
medical screening that involves a blood test of electrolytes and a urine test for pregnancy.
Each screening visit will take 2 to 3 hours. At the end of treatment and 4 months after
treatment completion, participants will undergo 2 assessments, both of which will include 2
hours of interviews and questionnaires. During these assessments researchers will evaluate
weight; eating behavior; and associated problems with mood, anxiety, obsessive-compulsive
symptoms, self-concept, social adjustment, and other areas of psychosocial functioning.

Inclusion Criteria:

- Bulimia nervosa, as defined by DSM-IV, or bulimic symptoms, as defined as purging
episodes (with objective or subjective binge eating) that occur at least once per week
for the past 3 months

Exclusion Criteria:

- Past or current diagnosis of psychosis or bipolar disorder

- Inability to read English

- Medical instability, including electrolyte abnormalities

- Psychotherapy or pharmacotherapy initiated within 6 weeks of study entry

- Pregnant or lactating

- Drug or alcohol dependence in the past 6 months or drug or alcohol abuse in the past 6
weeks

- Severe cognitive impairment or mental retardation