Study of bulimia seeks participants

James Lock

The binge-purge rhythm of adolescent bulimia nervosa starts slowly. Yet doctors have never pinpointed how best to heal the disease before its destructive cycle gains years of momentum.

Now, psychiatrists at the School of Medicine and the University of Chicago are seeking volunteers for the largest-ever randomized controlled trial of bulimia treatments for adolescents. Only two small randomized trials have previously been done in this age group.

"We desperately need more information," said James Lock, MD, PhD, professor of psychiatry and behavioral sciences at Stanford and the study's senior investigator. "There are a lot of kids with these problems, and we don't know how to help them." Lock is also director of psychiatric services at the Comprehensive Eating Disorders Program at Lucile Packard Children's Hospital.

Prior bulimia-treatment trials focused on adult patients, Lock said, which is why the National Institute of Mental Health awarded his team a five-year, $2 million grant to compare bulimia treatments for young people. Full-blown bulimia affects 1 to 2 percent of adolescents, and another 2 to 3 percent display significant bulimic behaviors, Lock noted. Female patients outnumber males by five to one, he said.

The team will study three treatments that may help adolescent bulimics. Study subjects will be randomly assigned to receive 20 outpatient consultations using cognitive behavioral therapy, family therapy or individual psychotherapy. Cognitive behavioral therapy is widely recognized as the preferred bulimia treatment for adults, whereas family therapy is used in teens with anorexia nervosa. Individual psychotherapy has succeeded as an alternate treatment for bulimic adults and adolescents.

The research team plans to enroll 158 adolescents, 79 at each study site. Prospective participants must be boys or girls ages 12 to 18 with bulimia nervosa or significant bulimic behaviors. Participants and their families must be willing to be assigned to any of the three treatments, and agree to participate in six months of regular treatments and one year of follow-up. Interested individuals should contact research assistant Brittany Alvy at 723-9182.

The treatments take varied approaches to the disordered thought patterns and behaviors seen in bulimia, Lock said. All may have some usefulness for teens, but the scientists are not sure if one treatment will produce better results than others.

The pathology Lock hopes to heal stems from poor body image and an unhealthy focus on rigid dieting. Strict dieting sets up patients for lapses of control—binge-eating episodes. After binge eating on thousands of calories, patients purge with vomiting, laxatives or excessive exercise. They then feel guilty over their loss of control, fueling further negative thoughts and deepening the downward spiral.

Cognitive behavioral therapy works on changing patients' behaviors and thinking patterns related to food and to body image. The therapist aims to help the patient stop thoughts that overemphasize the importance of weight and shape and end severe, destructive dieting.

Family therapy focuses solely on eating behaviors. The patient's parents are involved in every therapy session, and the underlying goal is to change the home environment so that it reinforces healthy eating and discourages dieting. "In this treatment, we see parents as a resource to facilitate behavioral change," Lock said.

Individualized psychotherapy, rather than targeting eating, examines underlying life problems that contribute to negative self-image. For example, the therapist and patient might discuss social pressures to look thin or negative experiences such as depression, neglect or abuse.

"We hope early intervention will become a chronic, long-lasting strategy," Lock said. Instead of treating bulimia in adulthood, "after the horse is out of the barn," early treatment has a better shot at causing a lasting cure, he added.