Quality statement 4: Bulimia-nervosa-focused family therapy

Quality statement

Children and young people with bulimia nervosa are offered bulimia-nervosa-focused family therapy (FT-BN).

Rationale

FT-BN has a positive effect on remission, binge eating frequency and reducing hospitalisation rates.

Quality measures

Structure

Evidence of local arrangements to offer FT-BN to children and young people with bulimia nervosa.

Data source: Local data collection, for example, service specifications.

Process

Proportion of children and young people with bulimia nervosa who are offered FT-BN.

Numerator – the number in the denominator who are offered FT-BN.

Denominator –the number of children and young people diagnosed with bulimia nervosa.

Data source: Local data collection, for example, local audit of electronic records. 

Outcomes

a) Binge eating frequency for children and young people with bulimia nervosa.

Data source: Local data collection, for example using the eating disorder examination questionnaire (EDE-Q 6.0).

b) Purging frequency for children and young people with bulimia nervosa.

Data source: Local data collection, for example, using the eating disorder examination questionnaire (EDE-Q 6.0).

c) Rate of recovery for children and young people with bulimia nervosa.

Data source: Local data collection, for example, using the eating disorder examination questionnaire (EDE-Q 6.0).

What the quality statement means for different audiences

Service providers (such as community providers, secondary and tertiary care and non-NHS units) ensure that they have teams in place to offer FT-BN for children and young people with bulimia nervosa, and to monitor treatment response. They should also ensure that healthcare professionals have training in offering this therapy and have supervision with monitoring of competency.

Healthcare professionals (such as therapists) offer FT-BN to children and young people with bulimia nervosa and monitor the response to treatment. They establish a good therapeutic relationship with the child or young person and, if appropriate, with their family members or carers. They support and encourage the family to help the child or young person to recover by supporting self-monitoring bulimic behaviours and involving them in discussions. Later and final treatment phases will also entail therapists supporting and encouraging family or carer involvement in plans for appropriate independence and relapse prevention.

Commissioners (such as clinical commissioning groups, NHS England and local authorities) ensure that they commission services with the capacity and expertise to offer FT-BN to children and young people with bulimia nervosa, and to monitor treatment response.

Children and young people with bulimia are offered a type of treatment called bulimia-nervosa-focused family therapy (or FT-BN for short). It involves working with a practitioner (for example, a therapist) to explore the effects of bulimia nervosa and how their family can support them to get better. Usually there are between 18 and 20 sessions that last for 6 months.

Source guidance

Eating disorders: recognition and treatment (2017) NICE guideline NG69, recommendation 1.5.6

Definition of terms used in this quality statement

Bulimia-nervosa-focused family therapy

FT-BN for children and young people with bulimia nervosa should:

  • typically consist of 18 to 20 sessions over 6 months

  • establish a good therapeutic relationship with the person and their family members or carers

  • support and encourage the family to help the person recover

  • not blame the person, their family members or carers

  • include information about:

    • regulating body weight

    • dieting

    • the adverse effects of attempting to control weight with self-induced vomiting, laxatives or other compensatory behaviours

  • use a collaborative approach between the parents and the young person to establish regular eating patterns and minimise compensatory behaviours

  • include regular meetings with the person on their own throughout the treatment

  • include self-monitoring of bulimic behaviours and discussions with family members or carers

  • in later phases of treatment, support the person and their family members or carers to establish a level of independence appropriate for their level of development

  • in the final phase of treatment, focus on plans for when treatment ends (including any concerns the person and their family have) and on relapse prevention.

[NICE's guideline on eating disorders, recommendation 1.5.7]

Equality and diversity considerations

Family therapy may not be an appropriate psychological treatment option for children and young people who have been abused by family members or looked-after children and young people.