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NEDA TOOLKIT for Parents C — Psychiatric admission for people with bulimia nervosa should normally be undertaken in a setting with experience of managing this disorder. C — Health care professionals should be aware that patients with bulimia nervosa who have poor impulse control, notably substance misuse, may be less likely to respond to a standard program of treatment. As a consequence treatment should be adapted to the problems presented. Additional Considerations for Children and Adolescents 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. General Treatment of Atypical Eating Disorders C — In the absence of evidence to guide the management of atypical eating disorders (eating disorders not otherwise specified) other than binge eating disorder, it is recommended that the clinician considers following the guidance on the treatment of the eating problem that most closely resembles the individual patient’s eating disorder. Psychological Treatments for Binge Eating Disorder B — Other psychological treatments (interpersonal psychotherapy for binge eating disorder and modified dialectical behavior therapy) may be offered to adults with persistent binge eating disorder. A — Patients should be informed that all psychological treatments for binge eating disorder have a limited effect on body weight. C — When providing psychological treatments for patients with binge eating disorder, consideration should be given to the provision of concurrent or consecutive interventions focusing on the management of comorbid obesity. C — Suitably adapted psychological treatments should be offered to adolescents with persistent binge eating disorder. Pharmacological Interventions for Binge Eating Disorder B — As an alternative or additional first step to using an evidence based self-help program, consideration should be given to offering a trial of an SSRI antidepressant drug to patients with binge eating disorder. B — Patients with binge eating disorders should be informed that SSRIs can reduce binge eating, but the long-term effects are unknown. Antidepressant drug treatment may be sufficient treatment for a limited subset of patients. B — As a possible first step, patients with binge eating disorder should be encouraged to follow an evidence based self-help program. Definitions: Evidence Categories 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. I: Evidence obtained from a single randomized controlled trial or a meta-analysis of randomized controlled trials IIA: Evidence obtained from at least one well-designed controlled study without randomization IIB: Evidence obtained from at least one well-designed quasiexperimental study III: Evidence obtained from well-designed non- experimental descriptive studies, such as comparative studies, correlation studies, and case-control studies IV: Evidence obtained from expert committee reports or opinions and/or clinical experience of respected authorities A — Cognitive behavior therapy for binge eating disorder (CBTBED), a specifically adapted form of CBT, should be offered to adults with binge eating disorder. Page | 41