Choosing Assessment Instruments for Bulimia Practice and Outcome Research.

International lifetime prevalence estimates for bulimia nervosa range from 1.1% to 2.9% for women (Garfinkel et al., 1995; Hudson, Hiripi, Pope, & Kessler, 2007; Kendler, MacLean, Neale, & Kessler, 1991; Wade, Bergin, Tiggemann, Bulik, & Fairburn, 2006). Lifetime prevalence estimates are slightly lower among men (0.5%; Hudson et al., 2007) and adolescents (0.9%; Swanson, Crow, Le Grange, Swendsen, & Merikangas, 2011). However, commonly used interview methods may underestimate the prevalence of bulimia nervosa because of minimization and denial of symptoms (Hudson et al., 2007). Although relatively uncommon, bulimia nervosa poses a significant public health concern because of comorbidity with other psychopathology and reported role impairment. Almost 95% of those with bulimia nervosa met diagnostic criteria for at least one other disorder in the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association [APA], 2000; Hudson et al., 2007). Significant comorbidity with common mood, anxiety, substance use, and impulse-control disorders have been reported by multiple researchers (Hudson et al., 2007; Kendler et al., 1991). To compound the problems of high comorbidity and role impairment, fewer than half of individuals with bulimia nervosa seek treatment. In one study, only 43.2% sought treatment for their bulimia, although they were slightly more likely to seek treatment for other conditions (Hudson et al., 2007). Similar results have been reported for adolescents; most seek some form of treatment for a comorbid disorder rather than the eating disorder (Swanson et al., 2011). As the risk of bulimia nervosa increases with successive birth cohorts (Hudson et al., 2007), it is critical for researchers and clinicians to accurately identify those who meet diagnostic criteria in order to best help these clients. Crow et al. (2009) reported that bulimia nervosa had a 3.9% mortality rate, commensurate with the 4.0% mortality rate of anorexia nervosa. Furthermore, the risk of suicide increased across eating disorder diagnoses. Thus, although the majority of those who meet diagnostic criteria for bulimia nervosa report role impairment, fewer than half seek treatment, and those who do not receive the help they need may face serious consequences, including death. The identification of those with bulimia nervosa is consequently a pressing concern for clinicians and researchers today. Counseling outcome research is undertaken to determine the effectiveness and long-term staying power of counseling and psychotherapy interventions. The purpose of this study was to identify and review the six most commonly administered assessment instruments used in counseling outcome research on bulimia nervosa. Erford et al. (2013) conducted a meta-analysis of 111 clinical trials, and this current study is a secondary analysis of the frequency of use of these instruments and comparative results among effect sizes yielded by use of these instruments. Inclusion and exclusion criteria from the Erford et al. study were as follows: 1. Studies appeared in print between 1980 and 2010. 2. Studies were published in English with no limitation on the nation or culture of origin. 3. A treatment or intervention was implemented to directly reduce the symptoms of participants diagnosed with bulimia nervosa. 4. Treatment involved individual, group, or family approaches to counseling or psychotherapy. Drug trials were excluded. 5. Symptoms of bulimia nervosa were assessed by at least one standardized measurement procedure (e.g., self-report rating scale, frequency count). 6. Output data (means and standard deviations) were available for computation of mean gain effect sizes or mean difference effect sizes. 7. Participants were adolescents (age 13 years and older) or adults. 8. Studies had a minimum sample size of six participants. …