What are the recommended first-line treatment options for bulimia nervosa in primary care?

Recommended first-line treatment options for bulimia nervosa in primary care include:

• Bulimia-nervosa-focused guided self-help programmes using cognitive behavioural self-help materials, supplemented with brief supportive sessions (for example, 4 to 9 sessions lasting 20 minutes each over 16 weeks, initially weekly).
• If guided self-help is unacceptable, contraindicated, or ineffective after 4 weeks, individual eating-disorder-focused cognitive behavioural therapy (CBT-ED) should be considered. This typically consists of up to 20 sessions over 20 weeks, with an initial focus on engagement, education, and establishing regular eating patterns, followed by addressing eating disorder psychopathology and relapse prevention.
• Medication should not be offered as the sole treatment for bulimia nervosa in primary care.

For children and young people, bulimia-nervosa-focused family therapy (FT-BN) is recommended, but in adults, the above psychological treatments are first-line.

Throughout treatment, it is important to provide psychoeducation that psychological treatments have limited effect on body weight and to involve significant others if appropriate.

Referral to specialist eating disorder services should be made promptly if needed, but initial management in primary care focuses on these psychological interventions.

References: NICE NG69, NICE CKS