Cognitive-behavioral or psychodynamic therapy for people with bulimia nervosa

  • Antonios DakanalisEmail author
  • Giuseppe Riva
  • Santino Gaudio
  • Massimo Clerici

Since Russell’s original description of bulimia nervosa (BN) in 1979 [1], a large body of informative aetiological and treatment literature has been published on this serious eating disorder condition and its symptoms [2, 3, 4, 5, 6, 7, 8, 9, 10, 11]. Successful treatment of BN is critical because of its association with psychosocial impairment, severe comorbid psychopathology, and significant rates of medical complications and mortality [2, 3, 6, 9, 11]. Cognitive-behavioral therapy (CBT) is depicted in the specialized literature as the treatment of choice for BN and was given the highest rating in the National Institute of Mental Health review of evidence-based treatments [3, 12]. However, as elegantly explained by Abbate-Daga and colleagues in their comprehensive review of psychodynamic psychotherapy (PDT) for eating disorders (including BN) published in this journal, PDT could also be of interest since psychodynamic models pioneered the understanding of eating disorders (BN...


Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study, formal consent is not required.


  1. 1.
    Russell G (1979) Bulimia nervosa: an ominous variant of anorexia nervosa. Psychol Med 9:429–448. doi: 10.1017/S0033291700031974 CrossRefPubMedGoogle Scholar
  2. 2.
    Dakanalis A, Clerici M, Riva G, Carrà G (2017) Testing the DSM-5 severity indicator for bulimia nervosa in a treatment-seeking sample. Eat Weight Disord 22(1):161–167. doi: 10.1007/s40519-016-0324-2 CrossRefPubMedGoogle Scholar
  3. 3.
    Mitchell JE, Agras S, Wonderlich S (2007) Treatment of bulimia nervosa: where are we and where are we going? Int J Eat Disord 40:95–101. doi: 10.1002/eat.20343 CrossRefPubMedGoogle Scholar
  4. 4.
    Culbert KM, Racine SE, Klump KL (2015) Research review: what we have learned about the causes of eating disorders—a synthesis of sociocultural, psychological, and biological research. J Child Psychol Psychiatry 56:1141–1164. doi: 10.1111/jcpp.12441 CrossRefPubMedGoogle Scholar
  5. 5.
    Dakanalis A, Carrà G, Timko A, Volpato C, Pla-Sanjuanelo J, Zanetti A, Clerici M, Riva G (2015) Mechanisms of influence of body checking on binge eating. Int J Clin Health Psychol 15(2):93–104. doi: 10.1016/j.ijchp.2015.03.003 CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Keel PK, Brown TA (2010) Update on course and outcome in eating disorders. Int J Eat Disord 43:195–204. doi: 10.1002/eat.20810 CrossRefGoogle Scholar
  7. 7.
    Dakanalis A, Carrà G, Clerici M, Riva G (2015) Efforts to make clearer the relationship between body dissatisfaction and binge eating. Eat Weight Disord 20(1):145–146. doi: 10.1007/s40519-014-0152-1 CrossRefPubMedGoogle Scholar
  8. 8.
    Bakalar JL, Shank LM, Vannucci A, Radin RM, Tanofsky-Kraff M (2015) Recent advances in developmental and risk factor research on eating disorders. Curr Psychiatry Rep. doi: 10.1007/s11920-015-0585-x CrossRefPubMedGoogle Scholar
  9. 9.
    Steinhausen H, Weber S (2009) The outcome of Bulimia Nervosa: findings from one-quarter century of research. Am J Psychiatry 166:1331–1341. doi: 10.1176/appi.ajp.2009.09040582 CrossRefPubMedGoogle Scholar
  10. 10.
    Dakanalis A, Pla-Sanjuanelo C, Caslini M, Volpato C, Riva G, Clerici M, Carrà G (2016) Predicting onset and maintenance of men’s eating disorders. Int J Clin Health Psychol 16(3):247–255. doi: 10.1016/j.ijchp.2016.05.002 CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Ágh T, Kovács G, Supina D, Pawaskar M, Herman BK, Vokó Z, Sheehan DV (2016) A systematic review of the health-related quality of life and economic burdens of anorexia nervosa, bulimia nervosa, and binge eating disorder. Eat Weight Disord 21(3):353–364. doi: 10.1007/s40519-016-0264-x CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Wilson GT, Shafran R (2005) Eating disorders guidelines from NICE. Lancet 365(9453):79–81. doi: 10.1016/S0140-6736(04)17669-1 CrossRefPubMedGoogle Scholar
  13. 13.
    Abbate-Daga G, Marzola E, Amianto F, Fassino S (2016) A comprehensive review of psychodynamic treatments for eating disorders. Eat Weight Disord 21(4):553–580. doi: 10.1007/s40519-016-0265-9 CrossRefPubMedGoogle Scholar
  14. 14.
    Stefini A, Salzer S, Reich G, Horn H, Winkelmann K, Bents H, Rutz U, Frost U, von Boetticher A, Ruhl U, Specht N, Klaus-Thomas K (2017) Cognitive-behavioral and psychodynamic therapy in female adolescents with bulimia nervosa: a randomized controlled trial. J Am Acad Child Adolesc Psychiatry 56:329–335. doi: 10.1016/j.jaac.2017.01.019 CrossRefPubMedGoogle Scholar
  15. 15.
    Reich G, Horn H, Winkelmann K, Kronmuller KT, Stefini A (2014) Psychodynamic focal therapy of bulimia nervosa for female adolescents and young adults. Praxis Kinderpsychologie Kinderpsychiatrie 63(1):2–20CrossRefGoogle Scholar
  16. 16.
    Dakanalis A, Carrà G, Calogero R, Zanetti MA, Gaudio S, Caccialanza R, Riva G, Clerici M (2015) Testing the cognitive-behavioural maintenance models across DSM-5 bulimic-type eating disorder diagnostic groups: a multi-study. Eur Arch Psychiatry Clin Neurosci 265(8):663–776. doi: 10.1007/s00406-014-0560-2 CrossRefPubMedGoogle Scholar
  17. 17.
    Bell EC, Marcus DK, Goodlad JK (2013) Are the parts as good as the whole? A meta-analysis of component treatment studies. J Consult Clin Psychol 81:722–736. doi: 10.1037/a0033004 CrossRefPubMedGoogle Scholar
  18. 18.
    Poulsen S, Lunn S, Daniel S, Folke S, Mathiesen BB, Katznelson H, Fairburn CG (2014) A randomized controlled trial of psychoanalytic psychotherapy or cognitive-behavioral therapy for bulimia nervosa. Am J Psychiatry 171:109–116. doi: 10.1176/appi.ajp.2013.12121511 CrossRefPubMedGoogle Scholar
  19. 19.
    Mitchell JE, Roerig J, Steffen K (2013) Biological therapies for eating disorders. Int J Eat Disord 46(5):470–477. doi: 10.1002/eat.22104 CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Department of Medicine and SurgeryUniversity of Milano-BicoccaMonzaItaly
  2. 2.Department of Brain and Behavioral SciencesUniversity of PaviaPaviaItaly
  3. 3.Applied Technology for Neuro-Psychology LaboratoryIRCSS Istituto Auxologico ItalianoMilanItaly
  4. 4.Department of PsychologyCatholic University of MilanMilanItaly
  5. 5.Department of Neuroscience, Functional PharmacologyUppsala UniversityUppsalaSweden

Personalised recommendations