Evaluation of internet-based, guided, self-help, cognitive behavioural therapy for bulimia nervosa and similar eating disorders in a specialist outpatient setting

INTERVENTION: The current project has three treatment arms. 1. One is a bibliotherapy‐based guided self‐help (GSH) cognitive behavioral therapy (CBT) with Internet support. The CBT‐based self‐help manual 'Overcoming Binge Eating', Swedish translation is used. It contains facts about eating disorders (EDs), and a six‐step self‐help program with detailed instructions, assignments and checklists. 2. Salut BN is a purely interactive CBT‐GSH in seven‐steps with assignments, diagrams and checklists. In both treatments, the patients have weekly contact with their therapist for feedback, guidance and support. The maximum length of treatment is 24 weeks. Therapists are three psychologists who were trained in CBT prior to the study. Approximately 11 therapist hours are required per patient in these two treatments. 3. The day patient program (DPP) is a psychodynamic intensive group treatment with group‐ and individual therapy, meals, body knowledge, and art therapy. Eight patients participate in each group, 3.5 hours daily. The staff at DPP is a medical doctor, an art therapist, psychologists, psychotherapists, physiotherapists, dieticians, psychiatric nurses and social workers. Length of treatment is 16 weeks. Approximately 200 therapist hours are required per patient in this treatment. CONDITION: Bulimia nervosa and similar eating disorders not otherwise specified ; Mental and Behavioural Disorders ; Bulimia nervosa PRIMARY OUTCOME: 1. Pre‐ and post‐treatment symptoms of eating disorder; 2. Comorbidity, self‐image; 3. Clinical impairment; 4. Motivation ; They are assessed with the computerized 'Stepwise' system which contains several clinical‐ and self ‐assessments: ; 1. Structured Clinical Interview for DSM‐IV Axis I Disorders (SCID‐I), a clinical interview for assessment of comorbid psychiatric disorders; 2. Structured Eating Disorder Interview (SEDI), a clinical interview for assessment of DSM‐IV eating disorder diagnosis; 3. The Eating Disorder Examination Questionnaire (EDE‐Q), a 36‐item self‐assessment of dietary restraint, eating concern, shape concern, weight concern, and frequency of episodes of disturbed eating‐ and compensatory behaviours during the past 28 days; 4. The Structural Analysis of Social Behaviour (SASB) Intrex introject, a self‐assessment of self‐image in 36 statements describing self‐directed behaviours; 5. The Comprehensive Psychopathology Rating Scale self‐assessment for Affective syndromes (CPRS‐S‐A), a self‐assessment that measures depression, anxiety, and obsession‐compulsion during the past three days on a 7‐step scale; 6. The Clinical Impairment Assessment (CIA), a 16‐item self‐report that measure impairment due to eating disorder; 7. The Bulimia Nervosa Stages of Change Questionnaire (BNSOCQ), a 20‐item self‐report that assess motivation to recover from bulimia nervosa. SECONDARY OUTCOME: 1. Predictors of treatment outcome (one year post‐treatment); 2. Long‐term follow‐up (three years post‐treatment); Methods used for measuring the secondary outcome measures are the same as mentioned above. INCLUSION CRITERIA: 1. Diagnosed with bulimia nervosa, sub‐threshold bulimia, or binge eating disorder if there has been a history of recurrent compensatory behaviour within the past year. 2. Body mass index (BMI) 17.5‐34 3. Minimum 18 years of age 4. Fluent in Swedish 5. Continuous access to the Internet