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BN Stepped Care First Step — MRCPsych Paper B MCQ

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EasyEating DisordersBN Stepped Care First StepMRCPsych Paper B

A 24-year-old adult has newly diagnosed bulimia nervosa. They are medically stable, have not previously received psychological treatment for the eating disorder, and are willing to engage in treatment. According to NICE stepped-care recommendations, which psychological intervention should initially be considered?

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Correct answer: D — Bulimia-nervosa-focused guided self-help

The correct answer is D. NICE recommends initially considering bulimia-nervosa-focused guided self-help for an adult with bulimia nervosa. This uses cognitive behavioural self-help materials supplemented by brief supportive sessions. If it is unacceptable, contraindicated or ineffective after 4 weeks, individual CBT-ED should then be considered, so A is a subsequent stepped-care option rather than the usual first step. FT-BN is recommended principally for children and young people with bulimia nervosa. MANTRA and SSCM are specialist psychological treatments for adults with anorexia nervosa, not bulimia nervosa. The patient's medical stability, willingness to engage and absence of previous treatment make guided self-help the uniquely appropriate initial intervention.

Reference: National Institute for Health and Care Excellence. Eating disorders: recognition and treatment (NG69), recommendations 1.5.2–1.5.4: psychological treatment for bulimia nervosa in adults. Published 2017, last updated 2020, with minor changes through 2025. https://www.nice.org.uk/guidance/ng69/chapter/recommendations#treating-bulimia-nervosa