Twenty-eight patients with ICD-10 bulimia nervosa or atypical bulimia nervosa were given a cognitive-behavioral treatment handbook and were reassessed 4-6 weeks later. On a clinician-rated global improvement scale 12 patients had much improved and 8 patients had somewhat improved. Fifteen patients were abstinent of vomiting or laxatives at reassessment as opposed to five patients before treatment. Of the 21 patients who were bringing before treatment, 7 had a 75-100% reduction of binges and 5 had a 50-75% reduction of binges. Patients' nutritional knowledge increased significantly. A patient-administered hand-book may be a useful first intervention in the treatment of patients with bulimia nervosa.