Cognitive behaviour therapy response and dropout rate across purging and nonpurging bulimia nervosa and binge eating disorder: DSM-5 implications

Zaida Agüera, Nadine Riesco, Susana Jiménez-Murcia, Mohammed A. Islam, Roser Granero, Enrique Vicente, Eva Peñas-Lledó, Jon Arcelus, Isabel Sánchez, Jose M. Menchon, Fernando Fernández-Aranda

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Background: With the imminent publication of the new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), there has been a growing interest in the study of the boundaries across the three bulimic spectrum syndromes [bulimia nervosa-purging type (BN-P), bulimia nervosa-non purging type (BN-NP) and binge eating disorder (BED)]. Therefore, the aims of this study were to determine differences in treatment response and dropout rates following Cognitive Behavioural Therapy (CBT) across the three bulimic-spectrum syndromes.Method: The sample comprised of 454 females (87 BED, 327 BN-P and 40 BN-NP) diagnosed according to DSM-IV-TR criteria who were treated with 22 weekly outpatient sessions of group CBT therapy. Patients were assessed before and after treatment using a food and binging/purging diary and some clinical questionnaires in the field of ED. "Full remission" was defined as total absence of binging and purging (laxatives and/or vomiting) behaviors and psychological improvement for at least 4 (consecutive).Results: Full remission rate was found to be significantly higher in BED (69.5%) than in both BN-P (p < 0.005) and BN-NP (p < 0.001), which presented no significant differences between them (30.9% and 35.5%). The rate of dropout from group CBT was also higher in BED (33.7%) than in BN-P (p < 0.001) and BN-NP (p < 0.05), which were similar (15.4% and 12.8%, respectively).Conclusions: Results suggest that purging and non-purging BN have similar treatment response and dropping out rates, whereas BED appears as a separate diagnosis with better outcome for those who complete treatment. The results support the proposed new DSM-5 classification. © 2013 Agüera et al.; licensee BioMed Central Ltd.
Original languageEnglish
Article number285
JournalBMC Psychiatry
Publication statusPublished - 7 Nov 2013


  • Binge eating disorder (BED)
  • Bulimia nervosa (BN)
  • Classification
  • Cognitive-behavioural therapy (CBT)
  • DSM-5


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