Treatment outcomes for adolescent bulimia nervosa: a systematic scoping review of quantitative findings

This study aimed to systematically scope the available quantitative evidence for adolescent Bulimia Nervosa (BN) interventions. Specifically, the study aimed to review psychological and behavioural symptoms outcomes, as well as changes in comorbid psychiatric and caregiver factors.

Five main and three grey literature databases were searched on 4th September 2024. Eligible peer-reviewed journal articles, dissertations and book chapters were included. Studies included children and adolescents with primary diagnoses of Bulimia Nervosa, Eating Disorder Not Otherwise Specified (EDNOS-BN) and Other Specified Feeding and Eating Disorder (OSFED-BN).

Findings from 18 studies (seven randomised controlled trials, three secondary analyses, eight single-arm studies) encompassing 710 participants were synthesised. All studies were conducted in the USA (10/18, 55.6%), UK (4/18, 22.2%), and mainland Europe (4/18, 22.2%). Most were conducted in an outpatient setting (14/18, 77.8%), with the remainder conducted in a day hospital (2/18, 11.1%), mixed outpatient/day hospital (1/18, 5.6%), or residential (1/18, 5.6%) setting. Family-focused therapies (10/18, 55.6%) and cognitive behavioural therapies (10/18, 55.6%) were most represented. Both were associated with improvements in BN psychopathology, comorbid difficulties and parent/caregiver factors. Weak evidence in favour of adjunctive therapies and Fluoxetine were reported.

There is a striking paucity in adolescent bulimia nervosa intervention research. Whilst family-focused and cognitive behavioural therapies show promise, the evidence base is relatively small. Most studies had small sample sizes and were conducted with predominately White, female participants. Very little data are available regarding parent/caregiver outcomes. Future research focusing on theory-driven mechanisms that target the broader presentation of BN are needed.