Treatment of laxative abuse in a female with bulimia nervosa using an operant extinction paradigm.

Chronic laxative abuse was treated using an operant extinction paradigm in a 29-year-old woman with bulimia nervosa. Access to self-administration of laxative and placebo were alternated in an ABAB design. Outcome was measured by self-reported craving for laxatives and rates of drug self-administration. During baseline, the subject exhibited high rates of both craving and self-administration. During placebo phases, cravings and drug self-administration declined. Both measures increased when active drug was reinstated. The final return to placebo led to a decrease in craving and extinction of drug self-administration to zero doses per day. This paper introduces the concept of laxatives as reinforcers and provides a new approach to the treatment of laxative abuse in women with bulimia nervosa.