Mental health articles

OF mental health care and mentally ill

Matching patients to treatments in bulimia nervosa

In contrast to anorexia nervosa, there is no evidence to support the need to match patients to treatment in bulimia nervosa. Although a number of pretreatment prognostic indicators have been identified, few of them have been replicated across studies and across different treatments. Hay and Bacaltchuk’s systematic review found no evidence of heterogeneity between studies, which might support treatment-matching. Severity and duration of bulimic symptoms have had an inconsistent link to outcome. There seems to be somewhat more agreement that personality disorder features such as borderline or impulsive features predict a poorer outcome. However, the main conclusion to be drawn with confidence from the literature on pre-treatment outcome predictor variables is that none of the ones identified have any major utility in helping us choose which treatment is most helpful for a particular patient.

Issues of risk management are also less of a priority in the choice of treatment for bulimia nervosa. The need for admission or even daycare is relatively rare and the great majority of patients can be managed safely as outpatients. There are, however, some particular circumstances in which risk issues need to be identified at assessment and taken into account in planning the patients’ care, both in the short and longer term. These concern patients with self-harm and suicidality and other high-risk behaviours, those who are pregnant or have small children and those with medical comorbidity such as diabetes mellitus.

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