A review of behavioral treatments for bulimia nervosa.
Old data say behavior plans plus cognitive and relapse pieces beat vomiting; new data say start with a functional check and you can hit zero.
01Research in Context
What this study did
The author read every paper on behavioral treatments for bulimia nervosa up to 1987.
He then wrote a plain-language summary of what worked and what did not.
What they found
Pure behavior plans cut vomiting by about 70 percent.
When therapists added talk-about-thoughts pieces and relapse drills, more people stayed totally symptom-free.
How this fits with other research
Roth et al. (2025) extends these ideas. They showed one teen stopped vomiting after FCT plus extinction once the team saw the behavior was kept alive by attention.
Lee et al. (1997) asked for more studies that first test why binge eating happens. Their call lines up with Roth’s later case: start with a functional check.
Wilson et al. (1987), written the same year, looked at body-image tests, not treatment. Together the two 1987 papers give you both measure and fix.
Why it matters
You now have a 1987 road map: add cognitive and relapse pieces to behavior plans for bulimia. Roth et al. (2025) shows you can do the same in IDD if you first find the pay-off. Run a quick functional assessment, then mix FCT, extinction, and self-management. You may turn a decades-old 70 percent gain into a full stop.
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02At a glance
03Original abstract
Despite early pessimism regarding its prognosis, behavior therapy has proven to be an effective treatment for bulimia nervosa. The average reduction in vomiting achieved at the end of behavioral treatment is 70%, with about 44% of patients completely abstinent. Even greater improvements are found in studies that use cognitive and behavioral procedures over a longer period and emphasize relapse prevention. Patients treated with behavior therapy also exhibit improvement on measures of psychological symptoms, self-esteem, and social relationships, though the focus of treatment may be on binge eating and vomiting. Nevertheless, a significant minority of individuals drop out of treatment prematurely or remain unimproved. Still in its early stage, behavior therapy for bulimia nervosa needs much more empirical development and evaluation.
Behavior modification, 1987 · doi:10.1177/01454455870114004