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

TL;DR

This review summarizes the limited evidence on treatments for adolescent bulimia nervosa, highlighting the potential of family and cognitive behavioral therapies.

Contribution

The study provides a systematic scoping review of quantitative findings on adolescent bulimia nervosa interventions, emphasizing gaps in research and promising therapies.

Findings

Family-focused and cognitive behavioral therapies are associated with improvements in bulimia nervosa symptoms and comorbid difficulties.

There is weak evidence supporting the use of Fluoxetine as an adjunctive therapy for adolescent bulimia nervosa.

Most studies had small sample sizes and lacked diversity in participant demographics.

Abstract

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.

The online version contains supplementary material available at 10.1186/s40337-025-01236-8.

This study aimed to systematically scope the available evidence for adolescent Bulimia Nervosa (BN) intervention in terms of symptom outcomes, related difficulties and parent/caregiver factors. Five main and three grey literature databases were searched on 4th September 2024. Relevant peer-reviewed journal articles, dissertations and book chapters were included. Findings from 18 studies (seven randomised controlled trials, three secondary-analyses, eight single-arm studies) encompassing 710 people were synthesised. All studies were conducted in the USA, UK or mainland Europe. Family-focused therapies and cognitive behavioural therapies were most represented. Both were associated with improvements in adolescent BN symptoms, comorbid difficulties and parent/caregiver factors. One study looked at the impact of medication (Fluoxetine 60mg/daily), with promising findings. There is a striking lack of 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 with participants who identified as White and female. Very little data are available on the impact of treatment on parents/caregivers. More higher quality studies, with larger and more diverse participants are needed.

The online version contains supplementary material available at 10.1186/s40337-025-01236-8.

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