Dr Bronwyn Raykos, MPsych PhD, Senior Clinical Psychologist, Head of Eating Disorders Program at the Centre for Clinical Interventions
Eating disorders are serious psychiatric illnesses that affect people of all ages, races, ethnicities, body shapes and weights, sexual orientations and socio-economic statuses. Anorexia nervosa has the highest mortality rate of any psychiatric illness, with increased risk of suicide and medical complications. Many people with eating disorders look healthy yet may be extremely ill.
We know that early detection and intervention are crucial when it comes to eating disorders. Unfortunately, there are long waiting lists for specialised treatment services. This is particularly challenging for GPs who hold primary care of patients while they wait for specialist treatment.
Cognitive behavioural therapy guided self-help (CBT-GSH) is a structured, evidence-based treatment which may be suitable as a first-line or complementary intervention for older teenagers and adults experiencing mild to moderate presentations including bulimia nervosa, binge eating disorder, and disordered eating. In certain circumstances (e.g. precipitous weight loss at any size, medical instability at any size) it is most appropriate for patients to first seek assistance from a GP, psychologist, or mental health clinician, who may include CBT-GSH as part of a more extensive treatment plan. In cases of severe mental health conditions such as suicidal ideation, psychosis, and/or severe or persistent depression, CBT-GSH alone is unlikely to be a sufficient intervention.
The Centre for Clinical Interventions (CCI) has responded to the need for urgent, evidence-based treatments that are accessible to patients at the point of seeking help by developing a new cognitive behavioural therapy for eating disorders (CBT-ED) workbook, Break Free from ED. The new self-help workbook provides clear, scientific, and up-to-date information about eating disorders and guides consumers through key components of CBT-ED. The workbook is designed as an active, transdiagnostic guide to recovering from an eating disorder. Consumers may choose to work through it on their own or with support of a mental health clinician.
The modules in the workbook cover:
- features of eating disorders and risks, and common maintaining factors
- establishing weekly weighing
- using self-monitoring to understand patterns of eating as well as other eating disorder thoughts and behaviours
- steps towards eating regularly, adequately, and including feared foods as part of recovery, as well as how to use behavioural experiments to test out fears
- information and strategies for binge eating, purging, and driven exercise
- body checking and body avoidance
- examination of the role of negative core beliefs in keeping people vulnerable to eating disorders
- developing a relapse prevention action plan.
Below are the top three tips from the CCI for GPs who are managing patients with eating disorders in Western Australia:
Step 1: Advice and consultation
GPs anywhere in Western Australia can access free advice on medical management of patients with eating disorders through the WA Eating Disorders Outreach and Consultation Service (WAEDOCS) Tel: 1300 620 208 (09:00 to 16:00 Monday to Friday).
Step 2: Upskilling on eating disorders
The National Eating Disorders Collaboration (NEDC) has just released free training specifically for GPs wishing to get upskilled on eating disorders. Eating Disorder Core Skills: eLearning for GPs is accredited by the Royal Australian College of General Practitioners (RACGP) as a CPD Accredited Activity (40 points), the General Practice Mental Health Standards Collaboration (GPMHSC) as Mental Health CPD and the Australian College of Rural and Remote Medicine (ACRRM) under the Professional Development Program.
Other useful NEDC resources include:
- Cognitive Behavioural Therapy Guided Self Help (CBT-GSH) Fact Sheet provides further information for GPs to understand the role of CBT-GSH and how to take patients through the process, as well as indications and contraindications for treatment
- The newly released Management of eating disorders for people with higher weight: clinical practice guideline. This guideline supports all health professionals in the management of this under-recognised, under-treated, and stigmatised population.
Step 3: Direct your patient to CCI’s Break Free from ED guided self-help workbook
If you direct your patient to CCI’s Break Free from ED workbook they can get started immediately on recovery steps while they wait for specialist treatment. GPs can access the workbook through the HealthPathways Eating Disorders pathway under the tab “For patients”.
Visit the CCI website for more information