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The assessment and management of patients with eating disorders can cause significant anxiety for all involved in their care, particularly as many patients are ambivalent about treatment and may develop concerning physical complications. Anorexia nervosa has the highest standardised mortality rate of any psychiatric disorder and all eating disorders cause significant short and long term psychological and physical morbidity. In this article, we provide an overview of the current psychological, pharmacological and physical evidence based management of patients with eating disorders.
▶ ‘Most people with anorexia nervosa should be managed on an outpatient basis, with psychological treatment (with physical monitoring) provided by a healthcare professional competent to give it and to assess the physical risk of people with eating disorders.’
▶ ‘People with anorexia nervosa requiring inpatient treatment should be admitted to a setting that can provide the skilled implementation of refeeding with careful physical monitoring in combination with psychosocial interventions.’
▶ ‘Family interventions that directly address the eating disorder should be offered to children and adolescents with anorexia nervosa.’
Psychological therapies for anorexia nervosa
The National Institute for Health and Clinical Excellence (NICE) guidelines1 recommend specialised outpatient psychological therapies that should last at least 6 months. They specify that dietary counselling on its own is not appropriate. They are also mindful of the essential need for monitoring of associated physical risks of anorexia nervosa. The aims of treatment should be to ‘reduce risk, encourage weight gain and healthy eating, reduce other symptoms related to an eating disorder, and facilitate psychological and physical recovery’.
The psychological therapies suggested by NICE1 are cognitive behavioural therapy (CBT), interpersonal psychotherapy (IPT), cognitive analytic therapy (CAT) and focal psychodynamic therapy. The evidence base for the psychological treatment of anorexia nervosa is poor, apart from family therapy that directly addresses the eating disorder for children and adolescents.1 …
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