Parental Involvement Key to Battling Bulimia

TUESDAY Sept. 4, 2007 -- Parents can play a significant role in the treatment of teens with bulimia, a new study has found.

When parents were involved in a treatment program, the percentage of teens able to abstain from the eating disorder's binge-purge pattern after six months doubled.

"Families have often been seen as part of the problem, rather than part of the solution. Families have been getting a bad rap, so traditional treatment often excludes parents," said study author Daniel le Grange, director of the University of Chicago's eating disorders program. "That's why this study is so important. It builds on work [that shows] no one cares or loves adolescents more than their parents. Parents' instinct is to take care of their kids, so why keep them at bay. We need to channel their energies."

The study, published in the September issue of Archives of General Psychiatry, is the first randomized, controlled trial in the United States to look at treatment for teens with bulimia, le Grange said.

Some 1 percent to 2 percent of adolescents suffer from bulimia nervosa, characterized by a disabling pattern of gorging on food, then forcing oneself to vomit. Another 2 percent to 3 percent of teens have symptoms of bulimia, but fall short of a full diagnosis.

Health complications of the disorder can include electrolyte imbalances, gland swelling and loss of tooth enamel. Sufferers also often have other psychiatric conditions, including mood and anxiety disorders and substance abuse problems.

Treatment for teens with bulimia lags that for adults, and there's no established clinical practice for adolescents with the disorder, said le Grange, co-author of the book Help Your Teenager Beat an Eating Disorder.

Family-based therapy has shown promise in treating teens with the eating disorder anorexia. Anorexics often experience some of the same symptoms, raising the possibility that this type of therapy might also work for bulimics.

In general, however, we're "not very successful with eating disorders," said Andrea Vazzana, a clinical assistant professor of child and adolescent psychiatry at the New York University Child Study Center. "Post-treatment, the success rates are still pretty low."

More options are needed, she added.

The new trial involved 80 teens -- aged 12 to 19 -- with a diagnosis of bulimia nervosa or partial bulimia nervosa. They were randomly assigned to receive family-based treatment or supportive psychotherapy, both involving 20 visits to a clinic over a six-month period.

"Individuals in the two groups received the same dose and duration of treatment, but the content of the treatment was different," le Grange explained.

In the family-based treatment group, parents and even siblings attended sessions with the patient and also played an active role at home. In the control group, which was intended to replicate what typically would happen in actual practice, the parents were not involved and the treatment did not address the eating disorder as directly, le Grange said.

At the end of the treatment, almost 40 percent of the teens in family-based treatment had stopped binging and purging, compared to only 18 percent of those in the control group.

Six months after treatment had ended, almost 30 percent of those in family-based treatment still were not binging and purging, compared to only 10 percent of those in supportive psychotherapy.

It's unclear if it was the family's involvement or the focus on eating behavior that led to the better results, le Grange said.

Vazzana said: "I do think it [the family-based therapy] looks promising, mostly based on the good results they've had with patients with anorexia. It follows the same model. It makes sense that it would apply to individuals with bulimia."

In terms of research, however, a better control group comparison would have been cognitive behavioral therapy, Vazzana said.

"Supportive therapy isn't really a well-established treatment for bulimia, so it's not surprising that [the family-based therapy] was superior," she said. "A more stringent study would be to compare family-based therapy with cognitive behavioral therapy, which is probably in progress."

A second study, this one published in the September issue of Archives of Pediatrics & Adolescent Medicine, found that a school-based obesity prevention program helped prevent behaviors such as self-induced vomiting or taking laxatives and diet pills.

In this study, conducted by researchers at the Harvard School of Public Health, about 4 percent of middle-school girls who received regular health education began vomiting or abusing laxatives or diet pills compared with only 1 percent in the obesity prevention program, called 5-2-1-Go! The program apparently had no effect in middle-school boys.

More information

Visit the U.S. National Institute of Mental Health for more on eating disorders.

Posted: September 2007


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