Eating Disorders in Scotland - Recommendations for Management
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
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
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
Published Date: 15 November 2006