A brief non-judgmental interview and feedback session designed to enhance people's motivation to change their behavior added to a self-help program appears to be effective in treating some people with two common types of eating disorders –bulimia nervosa and binge eating disorder.
The finding comes from an as yet unpublished University of Washington doctoral dissertation and also suggests that the session, which uses a technique called motivational interviewing, may be a cost effective way of providing assistance to a population that is particularly resistant to treatment.
People with eating disorders are extremely difficult to treat and are "often ambivalent about seeking treatment," said UW psychology doctoral student Erin Dunn. "Most people with eating disorders don't seek treatment on their own. They are indecisive about change and generally seek help when prompted through family, friends or a physician."
Failure rates for treating eating disorders are high. Depending on the type of therapy used, only 30 to 50 percent of those treated for an eating disorder get better, and the percentages are lower for patients who completely cease the behaviors associated with their condition. In addition, the costs for treating an eating disorder are expensive, usually involving individualized and intensive therapy. Patient dropout rates also are high.
Dunn's research showed that 24 percent of people who received a motivational interview as part of a self-help program were abstinent from binge eating at the end of four months compared to nine percent who only received the self help program. People who received the interview cut the incidence of binge eating by 38 percent compared with those in the self-help group who reduced their frequency of binge eating by 25 percent.
More people who went through an interview were abstinent from purging than those who did not receive one, but the difference was not statistically significant. This was likely due to the small sample size, she said.
People who received the interview also experienced significant reductions, 15 percent on average, in negative thoughts about their weight, shape and eating behaviors. The negative thoughts of individuals in the self-help groups did not change.
Motivational interviewing is a style of therapy that is non-judgmental, empathetic, non-confrontational and "meets the client where they are at in a collaborative effort," according to Dunn. It has been found to be helpful in dealing with a variety of behaviors such as weight loss, adopting an exercise program, using sunscreen and substance abuse including alcohol, drug and tobacco use.
Millions of Americans are afflicted by eating disorders each year. Lifetime prevalence for bulimia runs between 1 and 4 percent of women and approximately 1 per cent for men. Between 2 and 5 percent of all adults are affected by binge eating disorder. Bulimia is characterized by binge eating at least twice a week for at least three months, followed by some form of purging such as vomiting or excessive exercising to prevent weight gain. Binge eating disorder is a syndrome whose definition has yet to be been finalized by the psychiatric community. It is marked by recurrent binge eating at least twice a week for six months without the purging behaviors found in bulimia.
In the UW study, the largest yet investigation using motivational interviewing to treat eating disorders, 90 college students who met the full or partial diagnosis for these two disorders were recruited. The subjects were predominantly female (88 percent) and white (60 percent) or Asian/Pacific Islander (29 percent). On average, participants were of normal weight, but 95 percent of them reported a desired weight that was less than their current weight. On average, they wished to weigh about 19 pounds less.
