Treatment of Patients with Eating Disorders

Publication Date: July 17, 2022
Last Updated: March 30, 2023

Assessment

Screening for Presence of an Eating Disorder

Statement 1

APA recommends screening for the presence of an eating disorder as part of an initial psychiatric evaluation. (1, C)
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Initial Evaluation of Eating History

Statement 2

APA recommends that the initial evaluation of a patient with a possible eating disorder include assessment of:
  • the patient’s height and weight history (e.g., maximum and minimum weight, recent weight changes);
  • presence of, patterns in, and changes in restrictive eating, food avoidance, binge eating, and other eating-related behaviors (e.g., rumination, regurgitation, chewing and spitting);
  • patterns and changes in food repertoire (e.g., breadth of food variety, narrowing or elimination of food groups);
  • presence of, patterns in, and changes in compensatory and other weight control behaviors, including dietary restriction, compulsive or driven exercise, purging behaviors (e.g., laxative use, self-induced vomiting), and use of medication to manipulate weight;
  • percentage of time preoccupied with food, weight, and body shape;
  • prior treatment and response to treatment for an eating disorder;
  • psychosocial impairment secondary to eating or body image concerns or behaviors; and
  • family history of eating disorders, other psychiatric illnesses, and other medical conditions (e.g., obesity, inflammatory bowel disease, diabetes mellitus).
(1, C)
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Quantitative Measures

Statement 3

APA recommends that the initial psychiatric evaluation of a patient with a possible eating disorder include weighing the patient and quantifying eating and weight control behaviors (e.g., frequency, intensity, or time spent on dietary restriction, binge eating, purging, exercise, and other compensatory behaviors). (1, C)
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Identification of Co-Occurring Conditions

Statement 4

APA recommends that the initial psychiatric evaluation of a patient with a possible eating disorder identify co-occurring health conditions, including co-occurring psychiatric disorders. (1, C)
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Initial Review of Systems

Statement 5

APA recommends that the initial psychiatric evaluation of a patient with a possible eating disorder include a comprehensive review of systems. (1, C)
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Initial Physical Examination

Statement 6

APA recommends that the initial physical examination of a patient with a possible eating disorder include assessment of vital signs, including temperature, resting heart rate, blood pressure, orthostatic pulse, and orthostatic blood pressure; height, weight, and body mass index (BMI) (or percent median BMI, BMI percentile, or BMI Z-score for children and adolescents); and physical appearance, including signs of malnutrition or purging behaviors. (1, C)
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Initial Laboratory Assessment

Statement 7

APA recommends that the laboratory assessment of a patient with a possible eating disorder include a complete blood count and a comprehensive metabolic panel, including electrolytes, liver enzymes, and renal function tests. (1, C)
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Initial Electrocardiogram

Statement 8

APA recommends that an electrocardiogram be done in patients with a restrictive eating disorder, patients with severe purging behavior, and patients who are taking medications that are known to prolong QTc intervals. (1, C)
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Treatment Plan, Including Level of Care

Statement 9

APA recommends that patients with an eating disorder have a documented, comprehensive, culturally appropriate, and person-centered treatment plan that incorporates medical, psychiatric, psychological, and nutritional expertise, commonly via a coordinated multidisciplinary team. (1, C)
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Recommendation Grading

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.

Overview

Title

Treatment of Patients with Eating Disorders

Authoring Organization

American Psychiatric Association

Publication Month/Year

July 17, 2022

Last Updated Month/Year

October 11, 2024

Document Type

Guideline

Country of Publication

US

Document Objectives

The goal of this guideline is to improve the quality of care and treatment outcomes for patients with eating disorders.  As described in “Scope of Document,” we focus primarily on anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED) rather than other DSM-defined feeding and eating disorders.

Target Patient Population

Adolescents, emerging adults, and adults with eating disorders

Inclusion Criteria

Male, Female, Adolescent, Adult, Child, Older adult

Health Care Settings

Ambulatory, Hospital, Outpatient, School

Intended Users

Nurse, nurse practitioner, physician, physician assistant, psychologist

Scope

Diagnosis, Assessment and screening, Treatment, Management

Diseases/Conditions (MeSH)

D001068 - Feeding and Eating Disorders, D056912 - Binge-Eating Disorder, D019959 - Feeding and Eating Disorders of Childhood, D004435 - Eating, D000855 - Anorexia, D000856 - Anorexia Nervosa, D002032 - Bulimia, D052018 - Bulimia Nervosa

Keywords

eating disorders, anorexia, bulimia, eating disorder

Source Citation

American Psychiatric Association: Practice Guideline for the Treatment of Patients with Eating Disorders, Fourth Edition. Washington, DC, American Psychiatric Publishing 2023.