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This article provides an overview of an emotionally focused family therapy intervention for bulimic adolescents referred to an outpatient hospital clinic. The article attempts to integrate theory, practice, and preliminary research results. Bulimia is viewed from the theoretical perspective of attachment theory as described by Bowlby (1969). The emotionally focused approach to creating more secure attachment in families is described, outcome on a small number of adolescents is noted, and the implications of these theoretical and empirical points are discussed. Although there have been numerous systemic formulations of bulimia nervosa (Roberto, 1986; Root, Fallen, & Friedrich, 1986) and systemic interventions have become established as an important part of treatment of eating disorders (Gurman, Kniskem, & Pinsof, 1986), the treatment of bulimia with outpatient family therapy is still in an early phase of development. Influential authors have popularized the use of family interventions for eating disorders in general (Minuchin, Roseman, & Baker, 1978; Selvini-Palazzoli, 1978), and there are some empirical data on the effectiveness of family therapy for anorexia nervosa (Dare, Eisler, Russell, & Szmukler, 1990). Although a few descriptions of family therapy for

The aim of this study was to retrospectively identify clinical variables assessed prior to treatment which were predictive of patients' dropping out versus completing a 10-week group cognitive-behavioral treatment program for bulimia nervosa. Following a lengthy initial assessment, 81 women meeting DSM-Ill-R criteria for bulimia nervosa (BN) were referred to one of twelve 10-week groups of 8 to 12 patients having bulimic symptoms. The dropout rate for those meeting full DSM-Ill-R criteria for BN was found to be 28.7%. A series of seven discriminant function analyses were performed to determine whether dropouts differed from completers in terms of depression, anxiety, difficulties in trust and relating to others, bulimic symptom severity, family environment, weight history and symptom duration, and severity of bulimic cognitions. Of these, only the factor assessing difficulties trusting and relating to others was found to significantly discriminate dropouts from completers. Implications of the findings are discussed in terms of clinical and research relevance in the field of eating disorders. 0

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The purpose of this study was to evaluate the effect of desipramine, a tricyclic antidepressant with relatively specific noradrenergic effects, on bulimic behaviour, eating attitudes, and mood. Using a double-blind crossover design, 47 normal weight bulimics were randomly assigned to receive either desipramine (150 mg/day) for six weeks, no drug for three weeks, followed by placebo for six weeks, or the reverse sequence. At weeks 0, 2, 4, 6, 9, 11, 13, and 15, each subject was assessed using the EDI, SCL-90, POMS and binge records. Plasma desipramine levels were obtained at weeks 4 and 13. Twenty-four subjects completed the entire fifteen week protocol, while 23 dropped out. Desipramine was significantly more effective than placebo in reducing the frequency of weekly binding, weekly vomiting, and the fatigue scale of the POMS. No significant effect of the drug was obtained on the EDI or the SCL-90. The clinical effect was modest. Desipramine's antibulimic effects were not associated with an alleviation of depressive symptoms.