Since the original description of bulimia nervosa as a common psychiatric disorder by Russell in 1979,<sup>14 Russell G. Bulimia nervosa: An ominous variant of anorexia nervosa Psychol Med 1979 ;  9 : 429-488  [cross-ref]

Cliquez ici pour aller à la section Références</sup> a large treatment literature has accumulated concerning this condition. Several alternative strategies have been used in the treatment of bulimia nervosa. Patients in many treatment programs receive some sort of nutritional or dietary counseling designed to stress the importance of resuming a pattern of appropriately sized and balanced meals to be consumed on a regular basis. Additionally, as described elsewhere in this issue, other strategies used include pharmacotherapy, primarily with antidepressants, and psychotherapy using a variety of individual and group approaches, often including cognitive behavioral therapy (CBT) or behavioral therapy techniques. Many of these treatment strategies have been shown to be effective in diminishing the frequency of bulimic behaviors and in improving associated problems, such as depression, over the course of short-term treatment trials. Although these various strategies all have a number of potential strengths and limitations, among the most important observations regarding the available treatments is the fact that they are not universally effective. Although both psychotherapeutic and psychopharmacologic techniques can produce marked reduction in target behaviors, the percentage of patients achieving complete abstinence has been modest in most controlled studies. Patients who achieve improvement but not complete cessation of symptoms may be at higher risk for experiencing a relapse into bulimic behavior than those individuals who achieve abstinence.<sup>12 Olmsted M.P., Kaplan A.S., Rockert W. Rate and prediction of relapse in bulimia nervosa Am J Psychiatry 1994 ;  151 : 738-743

Cliquez ici pour aller à la section Références</sup> If abstinence, then, is an appropriate (though certainly not exclusive) goal for the treatment of bulimia nervosa, it appears important to attempt to devise alternative treatment strategies that result in higher rates of abstinence, or else to combine or sequence treatment strategies that have been shown individually to be somewhat effective (but that produce suboptimal results when used in isolation). In this article we review the later of these two possibilities.

Combining CBT and psychopharmacologic medication is one strategy that has been used and studied extensively in the treatment of major depression; a more limited controlled treatment literature exists in the use of such combined treatments for bulimia nervosa, although the combination appears to be widely used clinically. Potential benefits of combined treatments include the possibility of converting nonresponders to treatment responders, the possibility of improving the response of partial responders so that they may achieve abstinence, and the possibility that combined treatments might affect different aspects of the illness. In addition to diminishing distress and various forms of morbidity, and perhaps mortality, such combinations may also diminish health care utilization and thus cost over the long run.