Bulimia nervosa treated with an adapted version of the Carroll’s Cognitive-Behavioural Approach For Therapy of Cocaine addiction

Introduction: although Cognitive-Behavioural Therapy (CBT) seems to be effective for the treatment of Bulimia Nervosa (BN), together with interpersonal psychotherapy and self-help approaches based on highly structured CBT treatment manuals, there is still a small body of evidence supporting such an efficacy and effectiveness. Case description: we here describe a case of BN purging type, diagnosed by means of the Structured Clinical Interview for DSM IV clinical version, which was treated with an adapted version of the Carroll’s Cognitive-Behavioural Approach for Treatment of Cocaine addiction. This approach focuses on: dealing with cravings and negotiating tough decisions; shoring up motivation and commitment to stop; recognizing and avoiding risky situations; recognizing seemingly irrelevant decisions. At first visit, the patient was 38 years old, had a 24-year history of illness, presented a total score of 90 at the Eating Disorder Inventory (EDI), was under the treatment of sertraline 150 mg per day, and had completed a standard Cognitive Behavioural (CB) therapy with poor results. The macro-analysis showed: BN purging type, hypothyroidism, vitiligo, and familial relational problems. After 12 sessions of the adapted version of Carroll’s CB Approach, the patient had stopped sertraline and had an EDI total score of 67. Three further sessions, focused on cognitive restructuring, were completed in order to consolidate the level of well-being. Comment: CBT adapted on the basis of the experience and the literature on the treatment of cocaine addiction seems a promising approach for BN patients who completed a standard CBT with poor outcome.