A behavioral program for the management of anorexia and bulimia

The results of a behavioral treatment program for two cases of anorexia and bulimia are presented. The program involved inpatient contingency management for weight gain, thought stopping, flooding, response prevention for bulimia and emesis, and training in self-monitoring skills of caloric intake and weight. The results for both cases indicate that the inpatient program was associated with specific increases in body weight and caloric consumption which were generally maintained at 2-year follow-ups. Flooding and response prevention also appeared to be generally successful in reducing both emesis and bulimia urges and episodes, whereas thought stopping did not appreciably change these behaviors. Serum pituitary gonadotropins (follicle-stimulating hormone and luteinizing hormone) were also restored to normal or near normal levels. Self-monitoring of eating behaviors including caloric intake, emesis, and bulimia seemed to be a useful maintenance strategy and provided timely data for the application of booster treatments during later follow-up intervals.