Focused Versus Enhanced Cognitive Behavioral Therapy for Treating Women With Bulimia Nervosa

Bulimia nervosa (BN) is a common eating disorder that is characterized by periods of
bingeing and purging. People with the dysregulated subtype of BN experience behavioral
impulsivity; disruption of cognitive, affective, behavioral, and neurophysiological
processes (dysregulation); interpersonal dysfunction; and poor treatment response. To date,
no therapies have been tested for this specific population, and it is unknown whether
therapy that directly focuses on treating BN symptoms or one that addresses both eating and
personality disorder symptoms is more effective. Cognitive behavioral therapy (CBT), which
concentrates on modifying patients' behaviors and ways of thinking, has been effective in
treating BN. This study will compare the effectiveness of two types of CBT, focused and
broad, in treating adult women with the dysregulated subtype of BN.

Participants in this single-blind study will be randomly assigned to receive 20 sessions of
either broad (enhanced) or focused CBT. Participants will meet with a therapist once or
twice weekly until 20 sessions have occurred. Broad CBT will address symptoms of BN, as well
as those of the personality disorder. Focused CBT will concentrate only on BN symptoms.
Before treatment begins, participants will complete a set of questionnaires pertaining to
their experiences with BN, depression, anxiety, and interpersonal relationships. The
questionnaires will be used throughout the study to assess participants' progress.
Participants will also attend a clinical interview lasting approximately 3.5 hours.
Questions will concern BN, other eating disorder symptoms, depression, anxiety, and
interpersonal relationships. Blood samples and vital signs will also be taken at the time of
the clinical interview and as needed later in the treatment process.

Inclusion Criteria:

- Diagnosis of bulimia nervosa

- Presence of borderline personality disorder features

- History of one mood or anxiety episode within 2 years prior to study entry

- If taking psychiatric medication, dose has been stable for at least 6 weeks at time
of study entry

Exclusion Criteria:

- Substance dependence

- Diagnosis of bipolar I disorder

- Psychosis

- Mental retardation

- Receiving psychosocial treatment