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Eur Eat Disord Rev. 2020 Mar 4. doi: 10.1002/erv.2729. [Epub ahead of print]

Remission in adolescents with bulimia nervosa: Empirical evaluation of current conceptual models.

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Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA.
Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA.
Department of Psychiatry and Behavioral Neurosciences, The University of Chicago, Chicago, Illinois, USA.



The few randomized clinical trials (RCTs) investigating adolescent treatment for bulimia nervosa (BN) suggest variability in both rates of, and criteria for remission. The current study examined reactivity in remission rates, relative to various conceptualizations of remission in a single RCT data set.


A data set of adolescents with BN who participated in an RCT (N = 110) was used to evaluate remission models based upon behavioral symptoms (e.g., binge eating), psychological symptoms (Eating Disorder Examination [EDE] scores), and combinations of these criteria.


At end-of-treatment (EOT), a remission model defined by behavioral symptom abstinence plus meaningful reduction in EDE global scores yielded comparable remission rates to a model defined by behavioral abstinence alone (i.e., 29% remitted). Participants with higher EOT EDE global scores were less likely to be abstinent from behavioral symptoms at 6- and 12-month follow-up (ps < .001).


Reduction in psychological symptoms with behavioral abstinence did not inform remission status at EOT, over and above behavioral symptom change alone. However, psychological symptom improvement by EOT may predict positive prognosis in posttreatment assessment. Results underscore the necessity of including psychological symptom improvement, as well as consistency across research and practice, in defining remission in adolescent BN.


adolescents; bulimia nervosa; eating disorders; remission


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