Treatment in primary care and pathways of care

In the NSF for Mental Health there is the suggestion that some eating disorders might be treated in primary care. However, there is very little evidence to support the efficacy of interventions in primary care. Indeed, such interventions may serve to maintain the disorder. A Dutch survey of 108 patients with eating disorders showed that 38 per cent of the patients received medication from their general practitioners. This was usually to palliate symptoms, e.g. vitamins, laxatives, hormones (to induce menses) and drugs to stimulate or suppress the appetite.

In the UK, 45 per cent of people with bulimia nervosa were prescribed an anti-depressant by their general practitioner. It is unusual for people within primary care to have the expertise or resources to provide evidencebased psychotherapeutic approaches such as CBT. In the UK, 80 per cent of cases of anorexia nervosa and 60 per cent of cases of bulimia nervosa are referred on for specialized help. It is possible that standards of care for the primary care of eating disorders will improve. For example, following the publication of the NSF for Mental Health many health authorities have produced care pathways for eating disorders. Also new technology such as cognitive behaviour therapy (CBT) administered by CD-ROM holds promise as an intervention that could be delivered in schools, colleges or in primary care settings.

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