Table 1.
Recommendations for treating eating disorders (ED) summarised from current treatment guidelinesa [23]
|
General Principles Treatment should include psychoeducation; weight monitoring; addressing physical and mental health (including self-harm or suicidal behaviour); involve a multidisciplinary team and coordinated care between services; include the person’s family members or significant others where appropriate; be mindful that individuals with an eating disorder are vulnerable to stigma and shame; be sensitive when discussing a person’s weight and appearance; assess and, where possible modify, the impact of the environment (e.g. social media). | ||
| Diagnosis | Principles specific to the eating disorder | Specific outpatient therapies recommended across the guidelines |
| Anorexia nervosa |
1. A key goal is to help patients reach a healthy body weight for their age 2. Explain to the patient and their family the effects of starvation on the brain and body, and the need to reverse starvation by nutritional rehabilitation 3. Weight gain is key to supporting other changes needed for recovery 4. When weighing consider sharing the results with the patient and family 5. Only offer dietary counselling as part of a multidisciplinary approach 6. Do not offer medication as a sole approach 7. Have clear criteria for moving to more intensive treatment, e.g. admission to hospital |
Children and adolescents: Family therapy for anorexia nervosa b (parent-focused and multi-family group also acceptable); ED-focused CBT (CBT-ED) enhanced with family involvement; adolescent-focused psychotherapy Adult: Maudsley anorexia nervosa treatment for adults (MANTRA); Specialist supportive clinical management (SSCM); CBT-ED; eating disorder-focused focal psychodynamic therapy |
| Bulimia nervosa |
1. Explain that psychological treatments have limited effect on body weight 2. Explain that dieting increases the chance of binge eating 3. Do not offer medication as a sole approach; SSRIs are recommended as an adjunct treatment |
Children and adolescents: CBT-ED with family involvement; bulimia nervosa-focused family therapy Adult: Guided self-help CBT-ED; CBT-ED; interpersonal psychotherapy |
| Binge eating disorder |
1. Explain that psychological treatments have limited effect on body weight 2. For adolescents, offer the same treatments as adults 3. Do not offer medication as a sole approach; SSRIs are recommended as an adjunct treatment |
Adolescents and adults: Guided self-help CBT-ED; CBT-ED; interpersonal psychotherapy |
| OSFED: Offer the treatment for the eating disorder it most closely resembles; ARFID: Does not currently appear in treatment guidelines, the reader is referred to Thomas, J., & Eddy, K. (2019). Cognitive-Behavioral Therapy for Avoidant/Restrictive Food Intake Disorder: Children, Adolescents, and Adults. (2019). Cambridge: Cambridge University Press. | ||
a Treatment guidelines included Royal Australian and New Zealand College of Psychiatrists Clinical Practice Guidelines for the Treatment of Eating Disorders, National Clinical Guidelines (Denmark), Clinical Practice Guidelines (France), S3-guidelines for Assessment and Treatment of Eating Disorders (Germany), Practice Guidelines for the Treatment of Eating Disorders (Netherlands), Clinical Practice Guidelines for Eating Disorders (Spain), Eating Disorders: Recognition and Treatment (United Kingdom), Practice Guidelines for the Treatment of Eating Disorders (USA)
b Family therapy for AN also known as Family Based Treatment, Maudsley Family Therapy