Full DBT is an expensive and demanding treatment but deserves consideration for patients with an eating disorder and co-morbid borderline personality disorder and self-harm. There is a need for a more systematic and thorough evaluation.

Guided self-help is a worthwhile initial response to bulimia nervosa and binge eating disorder. It is a treatment that could be delivered in primary care and in other non-specialist settings.

Background:Cognitive-behavioural self-help treatments are widely advocated as the first step in the management of bulimia nervosa. Very little is known about the characteristics and attitudes of patients who are able to utilize self-help treatments. Aims: The aim of this study was to identify whether there are any pretreatment differences in patient characteristics and patients' expectations about computerized self-help between those who do or do not take up this type of treatment. Subjects and Methods: 81 patients who were offered a CD-ROM-based selfhelp treatment for bulimia nervosa completed baseline assessments including a questionnaire assessing their attitudes to and past experiences with self-help, confidence in using a computer and knowledge about and ability to manage aspects of their eating disorder. Results: Patients who did not take up the CD-ROM-based treatment had a significantly lower expectation of the usefulness of self-help for themselves but not for others. There were no baseline differences between groups in terms of mean BMI and symptom severity, in particular there were no differences in previous utilization of self-help or attitudes to previous self-help, or differences in confidence in using a computer. Qualitative comments of participants who failed to take up the package highlighted a diverse range of concerns and anxieties about computer treatment, some of which were based on misunderstandings about this treatment. Conclusions: These findings show that patients' views about self-help need to be carefully explored and misconceptions corrected if self-help treatment is to be considered by a subgroup of patients.

The level of psychiatric comorbidity in this study mirrors that found by other investigators. The amount of perceived disability suffered by individuals with panic is considerable. This study may contribute to the argument that people with panic should be identified at an early stage, to prevent unnecessary investigation and ensure adequate treatment.

Aims and MethodTo look at whether the opening of a day programme for the intensive care of people with severe anorexia nervosa in Leicester had the expected impact on admission rates, length of stay, cost of treatment and also simple measures of whether patients got better. Is this day programme an effective resource?ResultsSince the opening of the day programme, in-patient bed days and overall costs of treatment for local patients have been reduced, and the early results in terms of weight gain and readmission rates are promising.Clinical ImplicationsWith many areas planning to set up eating disorder services for local patients, it is important to consider which are the best resources to invest in. The experience of a well-established specialist service in Leicester has shown that a day programme can be an enriching and cost-effective way to treat patients with anorexia nervosa, but that it does not replace the need for the availability of in-patient beds.