Background Information

Anorexia Nervosa vs Bulimia Nervosa (to be added)

Guidelines

Anorexia Nervosa Management

Core management principle:

• Reaching healthy body weight or BMI is a key goal
• Weight gain is key in supporting other psychological, physical and quality of life changes that are needed for improvement or recovery

Pharmacological interventions:

• Encourage to take an age-appropriate oral multi-vitamin and multi-mineral supplement until their diet includes enough to meet their dietary reference values
• Do not offer medication as the sole treatment for anorexia nervosa

Adults

1st line: offer one of the following psychological treatments:

• Individual eating-disorder-focused cognitive behavioural therapy (CBT‑ED)
• Maudsley Anorexia Nervosa Treatment for Adults (MANTRA)
• Specialist supportive clinical management (SSCM)

2nd line:

• Consider one that has not been attempted (one of the 3 above), or
• Eating-disorder-focused focal psychodynamic therapy (FPT)

Children and Young People

1st line:

• Anorexia-nervosa-focused family therapy (FT-AN) (give patient the option to have some single-family sessions – separate and together with family members or carers)

2nd line:

• Individual eating-disorder-focused cognitive behavioural therapy (CBT‑ED), or
• Adolescent-focused psychotherapy for anorexia nervosa

Low Bone Mineral Density in Anorexia Nervosa

Consider DEXA scan if

• After 1 year of being underweight in children and young people
• After 2 years of being underweight in adults

Consider treatment in those with long-term low body weight and low bone mineral density:

• <15 y/o → consider incremental oestrogen (physiological doses), if there is delayed puberty as well
• >15 y/o → consider transdermal 17‑beta‑estradiol with cyclic progesterone
• >18 y/o → consider bisphosphonates

Bing Eating Disorder Management

Do not offer medication as the sole treatment for binge eating disorder.

The following applies to both adults and children:

• 1st line: binge-eating disorder-focused guided self-help programme
• 2nd line: group eating-disorder-focused cognitive behavioural therapy (CBT-ED)
• 3rd line: Individual eating-disorder-focused cognitive behavioural therapy (CBT‑ED)

Bulimia Nervosa Management

Adults

1st line:

• Bulimia-nervosa-focused guided self-help

2nd line:

• Individual eating-disorder-focused cognitive behavioural therapy (CBT‑ED)

Children and Young People

1st line:

• Bulimia-nervosa-focused family therapy (FT-BN)

2nd line:

• Individual eating-disorder-focused cognitive behavioural therapy (CBT-ED)

References

Original Guideline