{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T17:17:31Z","timestamp":1792343851865,"version":"4.4.0"},"reference-count":53,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,11,17]],"date-time":"2021-11-17T00:00:00Z","timestamp":1637107200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:p>\n                    <jats:bold>Background:<\/jats:bold>\n                    Bulimia nervosa is a disabling psychiatric disorder that considerably impairs physical health, disrupts psychosocial functioning, and reduces overall quality of life. Despite available treatment, less than half of sufferers achieve recovery and approximately a third become chronically ill. Extreme and enduring cases are particularly resistant to first-line treatment, namely antidepressants and cognitive behavioral therapy, and have the highest rate of premature mortality. Here, we demonstrate that in such cases, repeated sessions of ketamine assisted psychotherapy (KAP) is an effective treatment alternative for improving symptoms.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Case Presentation:<\/jats:bold>\n                    A 21-year-old woman presented with extreme and enduring bulimia nervosa. She reported recurrent binge-eating and purging by self-induced vomiting 40 episodes per day, which proved refractory to both pharmacological and behavioral treatment at the outpatient, residential, and inpatient level. Provided this, her physician recommended repeated KAP as an exploratory and off-label intervention for her eating disorder. The patient underwent three courses of KAP over 3 months, with each course consisting of six sessions scheduled twice weekly. She showed dramatic reductions in binge-eating and purging following the first course of treatment that continued with the second and third. Complete cessation of behavioral symptoms was achieved 3 months post-treatment. Her remission has sustained for over 1 year to date.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Conclusions:<\/jats:bold>\n                    To our knowledge, this is the first report of repeated KAP used to treat bulimia nervosa that led to complete and sustained remission, a rare outcome for severe and enduring cases, let alone extreme ones. Additionally, it highlights the degree to which KAP can be tailored at the individual level based on symptom severity and treatment response. While its mechanism of action is unclear, repeated KAP is a promising intervention for bulimia nervosa that warrants future research and clinical practice consideration.\n                  <\/jats:p>","DOI":"10.3389\/fpsyt.2021.764112","type":"journal-article","created":{"date-parts":[[2021,11,17]],"date-time":"2021-11-17T00:02:44Z","timestamp":1637107364000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":32,"title":["Case Report: Unexpected Remission From Extreme and Enduring Bulimia Nervosa With Repeated Ketamine Assisted Psychotherapy"],"prefix":"10.3389","volume":"12","author":[{"given":"Anya","family":"Ragnhildstveit","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura Kate","family":"Jackson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Cunningham","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Good","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Quinn","family":"Tanner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Roughan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia","family":"Henrie-Barrus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,11,17]]},"reference":[{"key":"B1","volume-title":"Diagnostic and Statistical Manual of Mental Disorders: DSM-5","year":"2013"},{"key":"B2","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1016\/j.brat.2015.02.002","article-title":"Evaluation of the DSM-5 severity indicator for bulimia nervosa","volume":"67","author":"Grilo","year":"2015","journal-title":"Behav Res Ther."},{"key":"B3","doi-asserted-by":"publisher","first-page":"521","DOI":"10.1097\/YCO.0000000000000641","article-title":"Review of the burden of eating disorders: mortality, disability, costs, quality of life, and family burden","volume":"33","author":"van Hoeken","year":"2020","journal-title":"Curr Opin Psychiatry."},{"key":"B4","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s40519-021-01162-z","article-title":"An update on the prevalence of eating disorders in the general population: a systematic review and meta-analysis","author":"Qian","year":"2021","journal-title":"Eat Weight Disord."},{"key":"B5","doi-asserted-by":"publisher","first-page":"813","DOI":"10.1007\/s00127-019-01667-0","article-title":"Psychiatric comorbidity as a risk factor for the mortality of people with bulimia nervosa","volume":"54","author":"Himmerich","year":"2019","journal-title":"Soc Psychiatry Psychiatr Epidemiol."},{"key":"B6","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1007\/978-3-030-69341-1_6","volume-title":"Complex Cases and Comorbidity in Eating Disorders: Assessment and Management","author":"Dalle Grave","year":"2021"},{"key":"B7","doi-asserted-by":"publisher","first-page":"724","DOI":"10.1001\/archgenpsychiatry.2011.74","article-title":"Mortality rates in patients with anorexia nervosa and other eating disorders: a meta-analysis of 36 studies","volume":"68","author":"Arcelus","year":"2011","journal-title":"Arch Gen Psychiatry."},{"key":"B8","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1002\/erv.2178","article-title":"Mortality and its predictors in severe bulimia nervosa patients","volume":"21","author":"Huas","year":"2013","journal-title":"Eur Eat Disord Rev."},{"key":"B9","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1016\/j.jpsychires.2017.10.008","article-title":"Predictors of long-term recovery in anorexia nervosa and bulimia nervosa: data from a 22-year longitudinal study","volume":"96","author":"Franko","year":"2018","journal-title":"J Psychiatr Res."},{"key":"B10","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1111\/j.1600-0447.2010.01641.x","article-title":"A comprehensive meta-analysis of the risk of suicide in eating disorders","volume":"124","author":"Preti","year":"2011","journal-title":"Acta Psychiatr. 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