Bulimia nervosa involves the uncontrolled eating of an abnormally large amount of food in a short period, followed by compensatory behaviors, such as self-induced vomiting, laxative abuse, or excessive exercise. The following guidance is evidence-based.
As a possible first step, patients with bulimia nervosa should be encouraged to follow an evidence-based self-help programme. Awareness of the risk, careful monitoring and, where appropriate, close liaison with an experienced physician are important in the management of the physical complications of anorexia nervosa.
An average of 8—13 episodes of inappropriate compensatory The guideline screening eating disorders per week.
Feeding against the will of the patient should be an intervention of last resort in the care and management of anorexia nervosa.
Patients who are vomiting should be given appropriate advice on dental hygiene, which should include avoiding brushing after vomiting, rinsing with a non-acid mouthwash after vomiting, and reducing an acid oral environment for example, limiting acidic foods.
Enquiries in this regard should be directed to the British Psychological Society. Awareness of the risks and careful monitoring should be a concern of all health care professionals working with people with this disorder.
Psychiatric admission for people with bulimia nervosa should normally be undertaken in a setting with experience of managing this disorder. Psychological treatments for binge eating disorder 4.
Psychological treatments for binge eating disorder 4. Give children and young people the option to have some single-family sessions: Family interventions that directly address the eating disorder should be offered to children and adolescents with anorexia nervosa.
After full criteria for bulimia nervosa were previously met, some, but not all, of the criteria have been met for a sustained period of time. Children and adolescents with anorexia nervosa should be offered individual appointments with a health care professional separate from those with their family members or carers.
Awareness of the risk, careful monitoring and, where appropriate, close liaison with an experienced physician are important in the management of the physical complications of anorexia nervosa. Effective monitoring and engagement of patients at severely low weight or with falling weight should be a priority.
Service interventions for anorexia nervosa The following section considers those aspects of the service system relevant to the treatment and management of anorexia nervosa.
Selective serotonin reuptake inhibitors SSRIs specifically fluoxetine are the drugs of first choice for the treatment of bulimia nervosa in terms of acceptability, tolerability and reduction of symptoms.
Target groups for screening should include young women with low body mass index BMI compared with age norms, patients consulting with weight concerns who are not overweightwomen with menstrual disturbances or amenorrhoeapatients with gastrointestinal symptoms, patients with physical signs of starvation or repeated vomiting and children with poor growth.
Patients and, where appropriate, carers should be provided with education and information on the nature, course and treatment of eating disorders. As an alternative or additional first step to using an evidence-based self-help programme, consideration should be given to offering a trial of a SSRI antidepressant drug to patients with binge eating disorder.
Whenever possible patients should be engaged and treated before reaching severe emaciation. The involvement of a physician or paediatrician with expertise in the treatment of physically at-risk patients with anorexia nervosa should be considered for all individuals who are physically at risk.
Assessment and co-ordination of care 4. The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months. Patients with enduring anorexia nervosa not under the care of a secondary care service should be offered an annual physical and mental health review by their GP.
Additional considerations for children and adolescents 4. Common elements of the psychological treatment of anorexia nervosa 4.
Where management is shared between primary and secondary care, there should be clear agreement amongst individual health care professionals on the responsibility for monitoring patients with eating disorders. Identification and screening of eating disorders in primary care and non-mental health settings 4.
Interpersonal psychotherapy should be considered as an alternative to cognitive behaviour therapybut patients should be informed it takes eight to 12 months to achieve results comparable with cognitive behaviour therapy.
Medication for anorexia nervosa 1. Patients with binge eating disorders should be informed that SSRIs can reduce binge eating, but the long-term effects are unknown. A sense of lack of control over eating during the episode e.
Health care professionals without specialist experience of eating disorders, or in situations of uncertainty, should consider seeking advice from an appropriate specialist when contemplating a compulsory admission for a patient with anorexia nervosa regardless of the age of the patient.
The main update in the DSM-5 criteria for bulimia nervosa Table 2 3 is a decrease in the average frequency of bingeing and purging from twice to once a week.American Psychiatric Association (APA) practice guidelines provide evidence-based recommendations for the assessment and treatment of psychiatric disorders.
Practice guidelines are intended to assist in clinical decision making by presenting systematically developed patient. Treatment of Eating Disorders; Treatment of Bipolar Disorder; The National Guideline Clearinghouse is a public database of clinical practice guidelines from around the world that is maintained by the U.S.
Department of Health and Human Services’ Agency for Healthcare Research and Quality. Guidelines must meet criteria showing they comply.
This guideline makes recommendations for the identification, treatment and management of anorexia nervosa, bulimia nervosa, and atypical eating disorders (including binge eating disorder) in primary, secondary and tertiary care.
The guideline applies to adults, adolescents and children aged 8. New screening guidelines for eating disorders. McBride DL(1). Author information: (1)Kaiser Permanente Oakland Medical Center, Allston Way, Berkeley, CAUSA.
[email protected] The Practice Guideline for the Treatment of Patients With Eating Disorders, Third Edition, con- sists of three parts (A, B, and C) and many sections, not all of which will be equally useful for all readers.
American Psychiatric Association (APA) practice guidelines provide evidence-based recommendations for the assessment and treatment of psychiatric disorders. Practice guidelines are intended to assist in clinical decision making by presenting systematically developed patient.Download