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Bulimia Treatment — MRCPsych Paper B MCQ

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ModerateEating DisordersBulimia TreatmentMRCPsych Paper B

A 24-year-old woman with bulimia nervosa has completed 4 weeks of bulimia-nervosa-focused guided self-help without improvement. She continues to binge eat and induce vomiting about five times weekly. She is medically stable and has no acute suicide risk. According to NICE NG69, which treatment should be considered next?

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Correct answer: B — Individual eating-disorder-focused cognitive behavioural therapy (CBT-ED)

The correct answer is B. NICE recommends considering individual CBT-ED for an adult with bulimia nervosa when bulimia-focused guided self-help is ineffective after 4 weeks. Treatment typically comprises up to 20 sessions over 20 weeks and addresses regular eating, dietary restraint, shape and weight concerns, emotional triggers for binge eating, and relapse prevention. FT-BN is the recommended psychological treatment for children and young people rather than the standard next step for this adult. Inpatient admission is reserved for circumstances such as severe physical compromise or acute mental health risk, neither of which is present. Medication should not be offered as the sole treatment for bulimia nervosa, so fluoxetine monotherapy is inappropriate. MANTRA is a treatment for adults with anorexia nervosa, not bulimia nervosa.

Reference: National Institute for Health and Care Excellence. Eating disorders: recognition and treatment (NG69), recommendations 1.5.4, 1.5.5 and 1.5.11. Published 2017; updated 2020. https://www.nice.org.uk/guidance/NG69/chapter/recommendations