Cognitive-Behavioral and Psychodynamic Therapy in Female Adolescents With Bulimia Nervosa: A Randomized Controlled Trial.

OBJECTIVE: The authors compared cognitive-behavioral therapy (CBT) and psychodynamic therapy (PDT) for the treatment of bulimia nervosa (BN) in female adolescents. METHOD: In this randomized controlled trial, 81 female adolescents with BN or partial BN according to the DSM-IV received a mean of 36.6 sessions of manualized disorder-oriented PDT or CBT. Trained psychologists blinded to treatment condition administered the outcome measures at baseline, during treatment, at the end of treatment, and 12 months after treatment. The primary outcome was the rate of remission, defined as a lack of DSM-IV diagnosis for BN or partial BN at the end of therapy. Several secondary outcome measures were evaluated. RESULTS: The remission rates for CBT and PDT were 33.3% and 31.0%, respectively, with no significant differences between them (odds ratio [OR] = 0.90, 95% CI = 0.35-2.28, p = .82). The within-group effect sizes were h = 1.22 for CBT and h = 1.18 for PDT. Significant improvements in all secondary outcome measures were found for both CBT (d = 0.51-0.82) and PDT (d = 0.24-1.10). The improvements remained stable at the 12-month follow-up in both groups. There were small between-group effect sizes for binge eating (d = 0.23) and purging (d = 0.26) in favor of CBT and for eating concern (d = -0.35) in favor of PDT. CONCLUSION: CBT and PDT were effective in promoting recovery from BN in female adolescents. The rates of remission for both therapies were similar to those in other studies evaluating CBT. This trial identified differences with small effects in binge eating, purging, and eating concern. Clinical trial registration information-Treating Bulimia Nervosa in Female Adolescents With Either Cognitive-Behavioral Therapy (CBT) or Psychodynamic Therapy (PDT). http://isrctn.com/; ISRCTN14806095.

Terapia psicodinámica familiar de la anorexia nerviosa / Psychodynamic family therapy for anorexia nervosa / Teràpiafamiliar psicodinàmicade l’anorèxianerviosa

La anorexia nerviosa es un grave trastorno psicosomático, aunque muchas veces está íntimamente enlazado con las relaciones familiares. En algunos casos, también se produce en un contexto multifactorial, diferenciando cuatro niveles de desarrollo de la patología: el nivel biológico (neurofisiológico), el social, el familiar y el individual (psíquico). La dinámica familiar de la patología suele tener un elevado impacto en la relación terapéutica y en la dinámica de transferencia y contratransferencia. A continuación, se presentan la experiencia clínica y algunos resultados de estudios efectuados en las dinámicas familiares de la anorexia, así como también los pasos de su tratamiento. También se hablará sobre la indicación de las sesiones de terapia familiar y su ajuste al caso concreto. A través de las barricadas: entre profesores y estudiantes adolescentes

Anorexia nervosa is a severe psychosomatic disorder, but one that is often deeply interwoven with family interactions. In some cases it also appears in a multigenerational context. Four levels of development of the illness must be differentiated: the biological (neurophysiological), social, family and the individual (psychic) levels. The family dynamics involved with this illness often have a high degree of impact on the therapeutic relationship and the dynamic of transference and countertransference. Clinical experiences and some research results on the family dynamics of anorexia are presented, as well as the steps for treatment. Questions of indications for family therapy sessions and their setting will also be discussed

L’anorèxia nerviosa és un greu trastorn psicosomàtic, tot i que moltes vegades està íntimament enllaçat amb les relacions familiars. En alguns casos també es produeix en un context multifactorial, i es diferencien quatre nivells de desenvolupament de la malaltia: el nivell biològic (neurofisiològic), el social, el familiar i l’individual (psíquic). La dinàmica familiar de la malaltia sovint té un elevat impacte en la relació terapèutica i en la dinàmica de transferència i contratransferència. Seguidament es presenten l’experiència clínica i alguns resultats d’estudis efectuats en les dinàmiques familiars de l’anorèxia, així com també els passos del tractament. També es parlarà sobre la indicació de les sessions de teràpia familiar i de l’ajustament al cas concret