Short communication Predictors of early change in bulimia nervosa after a brief psychoeducational therapy Fernando Ferna ` ndez-Aranda a,b, *, Eva M. A ´ lvarez-Moya a,b , Cristina Martı ´nez-Viana a , Isabel Sa ` nchez a , Roser Granero c , Eva Penelo c , Laura Forcano b , Eva Pen ˜ as-Lledo ´ d a Eating Disorders Unit, Department of Psychiatry, University Hospital of Bellvitge, C/ Feixa Llarga, s/n, 08907 L’Hospitalet de Llobregat, Barcelona, Spain b CIBER Fisiopatologia Obesidad y Nutricio ´n (CIBERObn), Instituto Salud Carlos III, Spain c Laboratory of Applied Statistics, Departament de Psicobiologia I Metodologia, Universitat Auto `noma de Barcelona, 08193 Bellaterra, Barcelona, Spain d University of Extremadura Medical School, Clinical Research Center (CICAB), Hospital Universitario Infanta Cristina, 06071 Badajoz, Spain Introduction About 20–30% bulimia nervosa (BN) patients are found to respond well to alternative briefer interventions than cognitive- behavioral treatment (CBT), which are commonly used as a start for standard CBT treatments for BN, i.e., a six-session psychoedu- cational group (Davis, Olmsted, & Rockert, 1990; Davis, Olmsted, Rockert, Marques, & Dolhanty, 1997). Psychoeducational groups have also proved to be globally effective for improving adherence to treatment or reducing general psychopathology. There is a dearth of information on predictors of response to these commonly used initial treatments for BN. Olmsted, Kaplan, Rockert, and Jacobsen (1996) found that age (older patients) and lower severity of ED symptomatology were associated with early response to treatment. Concerning predictors of dropout or non- engagement, different clinical factors have been reported: high levels of bingeing and purging, more severe bulimic cognitions, high impulsivity, low self-directedness and personality disorders (Agras et al., 2000; Fassino, Abbate-Daga, Piero, Leombruni, & Rovera, 2003). Early change in purging frequency during the first 4 weeks of treatment (by session 6) seems to predict the outcome of BN at the end of CBT (Agras et al., 2000) and at 8 months follow-up (Fairburn, Agras, Walsh, Wilson, & Stice, 2004). Other baseline predictors of outcome are binge and vomit frequency, duration of BN, history of body weight, level of general psychiatric symptoms, history of substance abuse and personality traits such as self-directedness (Agras et al., 2000; Fairburn et al., 2004; Turnbull et al., 1997). There is a need for examining factors involved in the appearance of significant changes in bulimic behaviors during the first six sessions, or 4 weeks, of treatment. Therefore, the present study aimed to identify baseline predictors of response (as measured by presence of eating symptomatology and dropouts, and percentage of symptomatological reduction) both at the 4th week-session and at the end of a six-session psychoeducational treatment. Method Sample The total sample included 241 BN patients consecutively admitted to an outpatient Eating Disorders Unit (University Hospital of Bellvitge; Spain). Entry into the study was between January 2002 and September 2004. All patients were female and fulfilled DSM-IV Appetite 52 (2009) 805–808 ARTICLE INFO Article history: Received 29 April 2008 Received in revised form 16 March 2009 Accepted 24 March 2009 Keywords: Bulimia nervosa Predictors Outcome Therapy Psychoeducation ABSTRACT We aimed to examine baseline predictors of treatment response in bulimic patients. 241 seeking- treatment females with bulimia nervosa completed an exhaustive assessment and were referred to a six- session psychoeducational group. Regression analyses of treatment response were performed. Childhood obesity, lower frequency of eating symptomatology, lower body mass index, older age, and lower family’s and patient’s concern about the disorder were predictors of poor abstinence. Suicidal ideation, alcohol abuse, higher maximum BMI, higher novelty seeking and lower baseline purging frequency predicted dropouts. Predictors of early symptom changes and dropouts were similar to those identified in longer CBT interventions. ß 2009 Elsevier Ltd. All rights reserved. * Corresponding author at: Eating Disorders Unit, Department of Psychiatry, University Hospital of Bellvitge, C/ Feixa Llarga, s/n, 08907 L’Hospitalet de Llobregat, Barcelona, Spain. E-mail addresses: ffernandez@bellvitgehospital.cat (F. Ferna ` ndez-Aranda), ealvarez@bellvitgehospital.cat (E.M. A ´ lvarez-Moya), fendo@wanadoo.es (C. Martı ´nez-Viana), isasanchez@bellvitgehospital.cat (I. Sa ` nchez), roser.granero@uab.cat (R. Granero), eva.penelo@uab.cat (E. Penelo), lforcano@bellvitgehospital.cat (L. Forcano), elledo@unex.es (E. Pen ˜ as-Lledo ´ ). Contents lists available at ScienceDirect Appetite journal homepage: www.elsevier.com/locate/appet 0195-6663/$ – see front matter ß 2009 Elsevier Ltd. All rights reserved. doi:10.1016/j.appet.2009.03.013