There is very little evidence about the concurrent treatment of AOD use and bulimia nervosa. There is, however, some evidence to suggest that treating a person’s AOD use disorder may lead to improvements in bulimia nervosa [1430, 1452].
There are currently several evidence-based treatments available for bulimia nervosa as a single disorder, including CBT and CBT-E; IPT; FBT; DBT; and integrative cognitive-affective therapy (ICAT); in addition to multidisciplinary and combined therapies [1453]. Unlike anorexia nervosa, overall, these treatments have been shown to produce moderate to large reductions in symptomology [1454]. On average, an estimated 30-40% of people treated with these psychotherapies attain binge-purge abstinence, and effects appear to be maintained over the longer term after treatment has ceased [1453, 1454].
Most psychotherapy research to date has been conducted in relation to CBT [1444]. There is robust evidence supporting CBT treatment approaches (in particular those that are specific to ED, such as CBT-E [1453–1455]), with both national and international clinical guidelines recommending the use of CBT approaches as the first line of treatment [870, 1428, 1429, 1434, 1456]. These typically comprise of 16–20 clinician-led sessions. There is some evidence to suggest that self-guided CBT is effective, but less so than clinician-led CBT [1453].