NEDA TOOLKIT for Parents
C — If the patient with anorexia nervosa and those
with parental responsibility refuse treatment, and
treatment is deemed to be essential, legal advice
should be sought in order to consider proceedings
under the Children Act 1989.
C — 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.
Psychological Interventions for Bulimia
Nervosa C — For people with bulimia nervosa, the effective
dose of fluoxetine is higher than for depression (60 mg
daily). B — As a possible first step, patients with bulimia
nervosa should be encouraged to follow an evidence-
based self-help program.
B — No drugs, other than antidepressants, are
recommended for the treatment of bulimia nervosa.
B — Health care professionals should consider
providing direct encouragement and support to
patients undertaking an evidence based self-help
program, as this may improve outcomes. This may be
sufficient treatment for a limited subset of patients.
A — Cognitive behavior therapy for bulimia nervosa
(CBT-BN), a specifically adapted form of CBT, should
be offered to adults with bulimia nervosa. The course
of treatment should be for 16 to 20 sessions over 4 to 5
months. C — Adolescents with bulimia nervosa may be treated
with CBT-BN adapted as needed to suit their age,
circumstances, and level of development, and
including the family as appropriate.
B — When people with bulimia nervosa have not
responded to or do not want CBT, other psychological
treatments should be considered.
B — Interpersonal psychotherapy should be
considered as an alternative to CBT, but patients
should be informed it takes 8-12 months to achieve
results comparable with CBT.
Pharmacological Interventions for Bulimia
Nervosa B — As an alternative or additional first step to using
an evidence-based self-help program, adults with
bulimia nervosa may be offered a trial of an
antidepressant drug.
B — Patients should be informed that antidepressant
drugs can reduce the frequency of binge eating and
purging, but the longterm effects are unknown. Any
beneficial effects will be rapidly apparent.
Management of Physical Aspects of Bulimia
Nervosa Patients with bulimia nervosa can experience
considerable physical problems as a result of a range
of behaviors associated with the condition. Awareness
of the risks and careful monitoring should be a
concern of all health care professionals working with
people with this disorder.
C — Patients with bulimia nervosa who are vomiting
frequently or taking large quantities of laxatives
(especially if they are also underweight) should have
their fluid and electrolyte balance assessed.
C — When electrolyte disturbance is detected, it is
usually sufficient to focus on eliminating the behavior
responsible. In the small proportion of cases where
supplementation is required to restore electrolyte
balance, oral rather than intravenous administration is
recommended, unless there are problems with
gastrointestinal absorption.
Service Interventions for Bulimia Nervosa
The great majority of patients with bulimia nervosa
can be treated as outpatients. There is a very limited
role for the inpatient treatment of bulimia nervosa.
This is primarily concerned with the management of
suicide risk or severe self-harm.
C — The great majority of patients with bulimia
nervosa should be treated in an outpatient setting.
C — For patients with bulimia nervosa who are at risk
of suicide or severe self-harm, admission as an
inpatient or day patient, or the provision of more
intensive outpatient care, should be considered.
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