Eating disorders: Efficacy of pharmacological and psychological interventions

Eating disorders represent a spectrum of overlapping conditions that combine disturbances in eating with various forms of traditional psychopathology. Medications are often helpful in the management of the psychopathology associated with anorexia nervosa but no compound has been shown to assist weight gain reliably or alter other core features of the condition. Contingency management and other behavior therapy procedures are effective in promoting weight gain in anorexia nervosa. The limited effectiveness of cognitive interventions for anorexia nervosa may be due to the complex of physical symptoms associated with low body weight. Antidepressants reduce binging and purging in bulimia nervosa and binge eating disorder, although this action appears to be independent of any antidepressant effect. Cognitive/behavioral interventions also reduce binging and purging, and comparisons of this therapy with medication indicate that psychotherapy alone is more effective than medication alone. Moreover, changes produced by cognitive/behavioral interventions endure longer than medication where higher relapse rates are common. Most studies also reveal no advantage of medication over cognitive/behavioral therapy alone in the reduction of bulimic symptoms.