Recovery in bulimia nervosa

This chapter addresses first issues in definition around the question of recovery in bulimia nervosa (BN), next the natural history, and third the outcome with treatment including predictors that may be modified to enhance remission and reduce relapse or later recurrence rates. Remission in BN is most often defined as the absence of binge eating and purging behaviours. In addition some studies have used reduction in psychopathology as an alternate indicator of recovery. These studies were based on a quantitative measure of eating disorder weight/shape (or other) concerns e.g. being less than one standard deviation above the community mean of the global Eating Disorder Examination score. There is a consensus that remission is most likely sustained after one year and relapse after that time may be termed recurrence. Naturalistic studies suggest that about half or more of those with BN may have a good outcome in the longer-term, but for the remainder the disorder is persistent. Treatment outcome studies indicate that for those who engage in specific interventions and evidence based treatments (particularly psychotherapies such as cognitive behaviour therapy for bulimia nervosa) developed since the 1980s the likelihood of recovery is significantly increased. Whilst there are mixed outcomes in studies of prognostic factors, consistent pre-treatment factors identified include a history of psychological advsersity, borderline personality structure, depression and obesity. Consistent post-treatment prognostic features are achieving abstinence and good psychosocial adjustment. Thus treatments should address improving psychological resiliency, coping and co-morbidities.