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Objective: This treatment development study investigated the acceptability and efficacy of a modified version of dialectical behavior therapy (DBT) for bulimia nervosa (BN), entitled appetite focused DBT (DBT-AF). Method: Thirty-two women with binge/ purge episodes at least one time per week were randomly assigned to 12 weekly sessions of DBT-AF (n 5 18) or to a 6-week delayed treatment control (n 5 14). Participants completed the EDE interview and self-report measures at baseline, 6 weeks, and posttreatment. Results: Treatment attrition was low, and DBT-AF was rated highly acceptable. At 6 weeks, participants who were receiving DBT-AF reported significantly fewer BN symptoms than controls. At posttest, 26.9% of the 26 individuals who entered treatment (18 initially assigned and 8 from the delayed treatment control) were abstinent from binge/purge episodes for the past month; 61.5% no longer met full or subthreshold criteria for BN. Participants demonstrated a rapid rate of response to treatment and achieved clinically significant change. Discussion: Results suggest that DBTAF warrants further investigation as an alternative to DBT or cognitive behavior therapy for BN. [ABSTRACT FROM AUTHOR]