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Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.

Family-based and individual psychological treatment

Psychiatry · UK scope · Sources checked 27 Aug 2026 · Clinical review pending

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Therapy cannot substitute for stabilisation

Psychological work must not delay urgent medical care for physiological compromise, monitored nutrition for dangerous underfeeding, or same-day intervention for suicide, self-harm, safeguarding or acute food and fluid refusal.

Action: Reassess physical and psychiatric risk at every transition, arrange acute medical or mental-health care when indicated, and keep the specialist eating-disorder team involved so stabilisation and therapeutic engagement proceed together rather than sequentially.

Synopsis

Select and explain age-appropriate, diagnosis-specific psychological treatment for eating disorders, involve families without blame, measure early response and change an ineffective plan while maintaining medical and nutritional safety.

  • Match therapy to diagnosis and age: NICE pathways differ for anorexia nervosa, bulimia nervosa and binge-eating disorder, and the nearest clinical disorder guides treatment for OSFED.
  • For adults with anorexia nervosa, discuss eating-disorder-focused CBT, MANTRA and specialist supportive clinical management as genuine choices; focal psychodynamic therapy is a further option when appropriate.
  • For children and young people with anorexia nervosa, consider anorexia-nervosa-focused family therapy, with individual CBT-ED or adolescent-focused psychotherapy if family treatment is unsuitable, unacceptable or ineffective.
  • For children and young people with bulimia nervosa, offer FT-BN and consider individual CBT-ED if it is unacceptable, contraindicated or ineffective; for binge-eating disorder, offer the same stepped treatments as for adults with developmentally appropriate adaptations.
  • Adults with bulimia nervosa may begin focused guided self-help and move to individual CBT-ED if it is unacceptable, contraindicated or ineffective after four weeks.
  • Adults with binge-eating disorder should be offered guided self-help, followed when needed by group CBT-ED; individual CBT-ED is appropriate when group treatment is unavailable, declined or unsuitable.
  • Explain that early regular eating and reduced dietary restraint may precede weight change; treatment of binge-eating disorder is not primarily a weight-loss intervention.
  • Parents and partners can support meals and reduce accommodation of symptoms, but treatment should explicitly avoid blame and preserve developmentally appropriate privacy and autonomy.
  • Review progress using behaviour, nutrition, physical recovery, functioning and patient goals; do not continue an unchanged protocol indefinitely when risk or non-response persists.

    • Key red flags

    A falling pulse, recurrent syncope, dehydration, hypoglycaemia, electrolyte change or rapid continued loss needs urgent physical reassessment even when therapy attendance appears good.

    New suicidal intent, escalating self-harm, severe hopelessness or an unsafe home environment requires immediate risk and safeguarding action rather than waiting for the next scheduled session.

    Repeatedly missed meals, hidden purging, compulsive activity or inability of carers to implement an agreed plan may indicate that outpatient intensity and practical support are insufficient.

    Family conflict, coercion, abuse or fear disclosed in treatment must be explored privately and managed through safeguarding pathways; family involvement is not automatically safe or appropriate.

    Lack of weight or behavioural improvement at an agreed early review is information to reformulate treatment, not evidence that the patient is unmotivated or untreatable.

    Investigation priorities

    01
    Shared diagnostic formulationFirst step

    Identify the main eating-disorder behaviours, maintaining loops, developmental context, strengths and goals.

    Management branches

    Young person with anorexiaBuild a non-blaming family plan

    A child or young person has anorexia nervosa and can undertake specialist psychological treatment.

    1. Consider anorexia-nervosa-focused family therapy, usually 18–20 sessions across one year, explaining the temporary carer role and protected individual time.
    2. Review the treatment after four weeks and then at least every three months, alongside frequent physical and nutritional assessment.
    3. If family therapy is unacceptable, contraindicated or ineffective, offer individual CBT-ED or adolescent-focused psychotherapy and reconsider care intensity.
    Open full textbook →Answer 2 questions
    Sources and review status3 sources · checked 27 Aug 2026 · clinical review pending+
    Sources

    Sources and review status

    National guidance is shown before implementation-dependent detail. Apply principles in context and verify current guidance when a decision affects care. Source check completed 27 Aug 2026; clinical approval remains outstanding.

    • NICE NG69 eating disorders recommendationsDiagnosis-specific psychological treatment, duration, review and family involvement.
    • NICE QS175 eating disorders quality standardQuality statements on timely assessment, treatment and monitoring.
    • NHS eating disorders overviewPublic-facing UK description of symptoms, help and recovery.

    Editorial contact: Doctor’s Passport editorial team. Source-check date is separate from clinical approval. Report a content problem · Content changes

    Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom