Eating Disorders Flashcards
Psychological treatment for anorexia nervosa in adults
For adults with anorexia nervosa, consider one of:
individual eating-disorder-focused cognitive behavioural therapy (CBT-ED)
Maudsley Anorexia Nervosa Treatment for Adults (MANTRA)
specialist supportive clinical management (SSCM).
Individual CBT-ED programmes for adults with anorexia nervosa should:
typically consist of up to 40 sessions over 40 weeks, with twice-weekly sessions in the first 2 or 3 weeks
aim to reduce the risk to physical health and any other symptoms of the eating disorder
encourage healthy eating and reaching a healthy body weight
cover nutrition, cognitive restructuring, mood regulation, social skills, body image concern, self-esteem, and relapse prevention
create a personalised treatment plan based on the processes that appear to be maintaining the eating problem
explain the risks of malnutrition and being underweight
enhance self-efficacy
include self-monitoring of dietary intake and associated thoughts and feelings
include homework, to help the person practice in their daily life what they have learned.
MANTRA for adults with anorexia nervosa should:
typically consist of 20 sessions, with:
weekly sessions for the first 10 weeks, and a flexible schedule after this
up to 10 extra sessions for people with complex problems
base treatment on the MANTRA workbook
motivate the person and encourage them to work with the practitioner
be flexible in how the modules of MANTRA are delivered and emphasised
when the person is ready, cover nutrition, symptom management, and behaviour change
encourage the person to develop a ‘non‑anorexic identity’
involve family members or carers to help the person:
understand their condition and the problems it causes and the link to the wider social context
change their behaviour.
SSCM for adults with anorexia nervosa should
typically consist of 20 or more weekly sessions (depending on severity)
assess, identify, and regularly review key problems
aim to develop a positive relationship between the person and the practitioner
aim to help people recognise the link between their symptoms and their abnormal eating behaviour
aim to restore weight
provide psychoeducation, and nutritional education and advice
include physical health monitoring
establish a weight range goal
encourage reaching a healthy body weight and healthy eating
allow the person to decide what else should be included as part of their therapy.
If individual CBT-ED, MANTRA, or SSCM is unacceptable, contraindicated or ineffective for adults with anorexia nervosa, consider:
one of these 3 treatments that the person has not had before or
eating-disorder-focused focal psychodynamic therapy (FPT).
FPT for adults with anorexia nervosa should:
typically consist of up to 40 sessions over 40 weeks
make a patient-centred focal hypothesis that is specific to the individual and addresses:
what the symptoms mean to the person
how the symptoms affect the person
how the symptoms influence the person’s relationships with others and with the therapist
in the first phase, focus on developing the therapeutic alliance between the therapist and person with anorexia nervosa, addressing pro-anorexic behaviour and ego-syntonic beliefs (beliefs, values and feelings consistent with the person’s sense of self) and building self-esteem
in the second phase, focus on relevant relationships with other people and how these affect eating behaviour
in the final phase, focus on transferring the therapy experience to situations in everyday life and address any concerns the person has about what will happen when treatment ends.
Psychological treatment for anorexia nervosa in children and young people
Consider anorexia-nervosa-focused family therapy for children and young people (FT-AN), delivered as single-family therapy or a combination of single- and multi-family therapy. Give children and young people the option to have some single-family sessions:
separately from their family members or carers and
together with their family members or carers.
FT-AN for children and young people with anorexia nervosa should:
typically consist of 18–20 sessions over 1 year
review the needs of the person 4 weeks after treatment begins and then every 3 months, to establish how regular sessions should be and how long treatment should last
emphasise the role of the family in helping the person to recover
not blame the person or their family members or carers
include psychoeducation about nutrition and the effects of malnutrition
early in treatment, support the parents or carers to take a central role in helping the person manage their eating, and emphasise that this is a temporary role
in the first phase, aim to establish a good therapeutic alliance with the person, their parents or carers and other family members
in the second phase, support the person (with help from their parents or carers) to establish a level of independence appropriate for their level of development
in the final phase:
focus on plans for when treatment ends (including any concerns the person and their family have) and on relapse prevention
address how the person can get support if treatment is stopped.
Medication for anorexia nervosa
Do not offer medication as the sole treatment for anorexia nervosa.
- However, olanzapine can be given to treat co-morbid conditions
Medication for binge eating disorder
Do not offer medication as the sole treatment for binge eating disorder.
Medication for bulimia nervosa
Do not offer medication as the sole treatment for bulimia nervosa.
Which drug is not recomended for women with anorexia
Bisphosphonates due to lack of data about the benefits and safety, also cannot be used in pre-menopausal females
Adults with bulimia nervosa and binge eating disorder can be offered:
SSRI (fluoxetine 60mg OD)
Binge eating disorder treatment option
Lisdexamfetamine
