Eating Disorders in Scotland

Eating Disorders in Scotland - Recommendations for Management and Treatment

About the Report

The report makes recommendations for healthcare professionals in Scotland in identification, management and treatment of eating disorders in adults, adolescents and children.

Recommendations are made for referral to specialist services. The recommendations relate to tiers 0, 1, 2, and 3 of services for patients with an eating disorder set out in the Framework for Mental Health Services (2001).

The recommendations were developed by a group of healthcare professionals and lay representatives from across Scotland, under the joint chairmanship of Dr Chris Freeman and Dr Harry Millar.

The group reviewed the National Institute of Health and Clinical Excellence (NICE) Guideline 9 on Eating Disorders and has incorporated those recommendations which are directly applicable to the Scottish context into this document.

The evidence base for treatment of eating disorders varies by condition. For anorexia nervosa there is surprisingly little research. Only one area, family interventions, has a body of high quality evidence, focusing on children and adolescents. Therefore, the development group used current clinical best practice within NHSScotland to make consensus based recommendations for the management of anorexia nervosa. Bulimia nervosa and binge eating disorder both have substantial bodies of high quality evidence, allowing evidence based recommendations to be derived.

Eating Disorders in Scotland

Eating disorders are a group of conditions related to body image disturbance and abnormal eating behaviour; these include anorexia nervosa, bulimia nervosa and atypical eating disorders (including binge eating disorder).

In eating disorders there is not just a disturbance of eating behaviour, but also a very characteristic abnormal thinking pattern characterised by an extreme preoccupation with body shape and weight, and body disparagement. An important distinction is between disorders that occur in people of at least normal body weight and those that occur in people of low body weight.

Other conditions, including depression, anxiety, obsessional and personality disorders, often exist alongside eating disorders.

Prevalence estimates for the number of patients with eating disorders in Scotland are difficult to calculate given the likely numbers who do not seek medical help. It has been estimated that the annual incidence of anorexia nervosa is 8.1 per 100,000 population and incidence of bulimia nervosa is 11.4 per 100,000 population with approximately 90% of all cases present in women.

Further estimates suggest 30-50% of patients go on to experience long-term chronic problemsiv. Most general practitioners (GPs) see few patients with an eating disorder in any one year and as a result clear guidance for them and primary healthcare team members is required.


Published Date: 15 November 2006


Healthcare Improvement Scotland took over the responsibilities of NHS Quality Improvement Scotland on 1st April 2011.