CPG for Eating Disorders

Algorithm 4. Treatment of BN and BED1) It is recommended to follow the WHO’s (ICD-10) and the APA’s (DSM-IV or DSM-IV-TR) diagnostic criteria to establish the diagnosis of BN and BED. (Good clinicalpractice). Recommendation 7.1.2) Nutritional counselling and dental hygiene adviceThis type of intervention aims mainly to modify what the patient eats, as well as maladaptiveeating habits and attitudes, providing a model to follow (healthy diet, maintenance of a fixedeating schedule, eating three meals a day, eating normal rations according to age, eating with thefamily in a relaxed environment without distractions, without being the one to prepare the mealand resting after eating).In the case of laxative misuse, patients with BN must be advised on how to decrease and stopabuse. This process must be carried out gradually. Patients must also be informed that the useof laxatives does not decrease nutrient absorption. (Grade D). Recommendation 9.GM.8.When electrolyte imbalance is detected, in most cases elimination of the behaviour that caused itis sufficient to correct the problem. In a small number of cases, oral administration ofelectrolytes whose plasmatic levels are insufficient is necessary to restore normal levels, exceptin cases involving gastrointestinal absorption. (Grade D). Recommendation 9.GM.7.Patients who vomit habitually must have regular dental check-ups and be provided with dentalhygiene advice. (Grade D). Recommendation 9.GM.9.3) Psychological therapies– CBT-BN is a specifically adapted form of CBT and it is recommended that 16 to 20 sessionsare performed over 4 or 5 months of treatment. (Grade A). Recommendation 9.3.2.1.1.Patients with BN who do not respond to or refuse to receive CBT treatment may be offeredalternative psychological treatment. (Grade B). Recommendation 9.3.2.1.2.Adolescents with BN can be treated with CBT adapted to their age, level of development, and, ifappropriate, the family’s intervention can be incorporated. (Grade D). Recommendation9.3.2.1.3.Adult patients with BED can be offered a specifically adapted form of CBT. (Grade A).Recommendation 9.3.3.1.– A possible first step in the treatment of BED is to encourage patients to follow a SHprogramme (guided or not). (Grade B). Recommendation 9.GP.13.CLINICAL PRACTICE GUIDELINE FOR EATING DISORDERS204