When should I consider referring a patient with bulimia nervosa to specialist mental health services?

Consider referring a patient with bulimia nervosa to specialist mental health services immediately after an initial assessment if an eating disorder is suspected. Early referral to an age-appropriate eating disorder service is recommended to ensure timely specialist assessment and management, avoiding a watchful waiting approach.

Referral urgency depends on clinical judgement and the specific clinical situation, including the presence of serious physical complications, suicide risk, or serious self-harm risk.

Specialist services may include community mental health teams, child and adolescent mental health services (CAMHS), or specialist eating disorder units, depending on local pathways.

While awaiting specialist assessment, regular review should be arranged to monitor physical and mental health risks and to consider the need for urgent admission or further investigations.

Referral should be considered especially if the patient shows signs of physical health compromise, rapid weight loss, electrolyte imbalance, or if compensatory behaviours such as vomiting or laxative misuse are present.

Psychological treatments such as bulimia-nervosa-focused guided self-help or cognitive behavioural therapy (CBT-ED) are typically delivered by specialist services, so referral is necessary to access these interventions.

In children and young people, bulimia-nervosa-focused family therapy (FT-BN) is recommended and requires specialist involvement.

Overall, early referral improves recovery rates and reduces relapse risk, so a low threshold for referral is advised.

Consider emergency medical or psychiatric admission if there is risk of serious physical complications or suicide.

In summary, refer patients with bulimia nervosa promptly to specialist mental health services for assessment and treatment, especially if there are physical or mental health risks or if initial self-help interventions are ineffective or inappropriate.

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