This proposal for an independent Scientist Award (K02) to support my research program in the area of the treatment and outcome of eating disorders. This has been the focus of my work since finishing residency in 1992 and since 1995 I have been the principal investigator of an active and productive research group focused on eating disorders treatment and outcome issues. The application centers around R01 grant "Stepped Care vs. Best Available care for Bulimia Nervosa" (R01-MH-59304). This is a five year study (now in its third year) examining the use of different sequences of self-help, pharmacotherapy, and cognitive behavioral therapy to treat bulimia nervosa. In addition to measuring the efficacy of these various treatment packages, cost efficacy will also be measured. The Department of Psychiatry at the University of Minnesota has made a strong institutional commitment to this award. The department provides strong administrative support and a highly supportive environment for research activities, and recently completed construction of a 4000 square feet Psychiatry Ambulatory Research Center (ARC) that houses my ongoing research activities. If funded, this award will free me up from substantial clinical duties and protect fully 75% of my time for research activities. This increased time will allow for advanced specialized training in cost efficacy analysis, specific training in sophisticated clinical outcomes research techniques through the Clinical Outcomes Research Center at the University of Minnesota, active consultation regarding ED treatment study issues with B. Timothy Walsh, M.D and active consultation on eating disorder course and outcome study issues with Christopher Fairbum, M.D. These career development activities will enable me to utilize the unique research populations and data available at Minnesota to pursue my research goals in the areas of studying effective and cost effective treatment for eating disorders and examining their course and their costs. Numerous studies are planned during this award and in the years that follow to leverage these new skills and unique resources.