Does concurrent psychopathology at presentation influence response to treatment for bulimia nervosa?

Pub Med and Psych Lit were searched using the key terms 'outcome' and 'bulimia nervosa' for papers on outcome and bulimia nervosa (BN). The studies which examined any aspect of psychopathology are included and the findings reviewed. No robust findings emerged. This paper reviews the methodological problems that beset this area, and then examines in detail the relationship between other psychological dysfunctions and psychiatric co-morbidity and treatment outcome for BN. The psychological variables that most probably predict poorer outcome are low self-esteem, and low satisfaction with or perceived quality of friendships. With regard to psychiatric co-morbidity, there is no consistent relationship with any Axis I disorder. Most of the studies assessing Axis II dysfunction show that borderline symptom severity or cluster B personality disorder can impair outcome. The implications for clinical practice are discussed and directions for future research suggested.