What is multi‐impulsive bulimia and can multi‐impulsive patients benefit from supervised self‐help?

Abstract

Definitions of multi-impulsivity and sample characteristics between studies of impulsivity vary widely leading to inconsistent results. Outcome data was examined to assess the comparative response of multi-impulsive and non multiimpulsive bulimic patients to a supervised self-help CBT programme. Multiimpulsivity was defined as the presence of two or more impulsive behaviours in the last 2 months in addition to bulimia nervosa as reported with the MultiImpulsivity Scale. Multi-impulsive patients reported similar levels of bulimic behaviours but higher levels of depression at pre-treatment. They achieved similar levels of change by the end of treatment. However, despite improvements, their levels of depressive symptoms remain high and bulimic symptoms subclinical and may be at higher risk of relapse.

A critical evaluation of the efficacy of self‐help interventions for the treatment of bulimia nervosa and binge‐eating disorder

“…One consistent finding across the trials included in this review was that improvements in eating disorder symptoms were typically maintained at follow-up, [5][6][7][8]12,[14][15][16][17]21,22,25,27,28 which occurred between 3 and 18 months after the completion of treatment. However, only one study documented additional gains during the follow-up period.…”

“…Studies that included (1) only individuals with BN, (2) patients with BN or subthreshold BN, or (3) a mixed group of patients with the majority classified as BN were all designated as BN self-help studies for the purpose of our evaluation. Of the 20 BN self-help studies, seven were open trials of selfhelp, [3][4][5][6][7][8][9] five compared self-help to a waiting-list control, [10][11][12][13][14] eight compared self-help to another intervention, including treatments such as CBT, medication, or other forms of self-help, 11,13,[15][16][17][18][19][20] and two evaluated self-help combined with CBT. 21,22 Two studies 11,13 used multiple comparisons with self-help (patients were randomized to self-help, another intervention, or a waiting list), and these studies are described in all applicable categories (e.g., comparisons of self-help to a waiting list and comparisons of self-help to a comparison treatment).…”

“…21,22 Two studies 11,13 used multiple comparisons with self-help (patients were randomized to self-help, another intervention, or a waiting list), and these studies are described in all applicable categories (e.g., comparisons of self-help to a waiting list and comparisons of self-help to a comparison treatment). Eight studies of patients with BN utilized a PSH intervention, 3,[9][10][11]13,18,19,21 11 employed a GSH intervention, [4][5][6]8,12,[14][15][16][17]20,22 and one compared PSH and GSH. 7 Six studies of self-help for BED were identified, one was an open trial, 23 two compared self-help to a waiting list, 24,25 one compared self-help to a control condition, 26 two compared self-help to another intervention, such as other forms of self-help, 26,27 and one combined self-help with medication.…”

“…A comparison of findings from studies employing PSH for BN, EDNOS, 3,[9][10][11]13,18,19,21 or BED 24 versus GSH for BN, EDNOS, [4][5][6]8,12,[14][15][16][17]20,22 or BED 23,26,28 is complicated by the substantial difference in outcome measures across trials. However, the improvements are of a similar magnitude, with PSH interventions associated with 50.2%-86.7% decrease in eating disorder symptoms and with Indicates a difference between the face-to-face condition and all other conditions combined.…”

The possible influence of impulsivity and dietary restraint on associations between serotonin genes and binge eating

“…Although most women with BN have high levels of neuroticism (Diaz-Marsa et al, 2000), there is a distinct subgroup who are also impulsive and undercontrolled (Westen & Hardnen-Fischer, 2001; Wonderlich et al, 2005). These individuals exhibit a large number of co-morbid impulsive behaviors (e.g., substance use, sexual disinhibition) and are frequently categorized as “multi-impulsive BN” (Bell & Newns, 2002). Research suggests that this BN sub-phenotype may have different etiological underpinnings than other BN-sub-phenotypes (e.g., high-functioning and constricted/overcontrolled sub-types; Westen & Harnden-Fischer, 2001).…”