Treatment of Patients With Eating Disorders

Publication Date: July 17, 2022

Last Updated: February 28, 2023

Key Points

The goal of this guideline is to improve the quality of care and treatment outcomes for patients with eating disorders, as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR; American Psychiatric Association 2013).
We focus primarily on anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED) rather than other feeding and eating disorders.
The lifetime prevalence of eating disorders in the United States is approximately 0.80% for AN, 0.28% for BN, and 0.85% for BED.
The lifetime burdens and psychosocial impairments associated with an eating disorder can be substantial because these illnesses typically have an onset in adolescence or early adulthood and can persist for decades.
Eating disorders are associated with increases in all-cause mortality and deaths due to suicide.
Morbidity and mortality among individuals with an eating disorder are heightened by the common co-occurrence of health conditions, such as diabetes, and other psychiatric disorders, particularly depression, anxiety, posttraumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), attention-deficit/hyperactivity disorder (ADHD), and substance use disorders.
This guideline is intended to enhance the assessment and treatment of eating disorders, thereby reducing the mortality, morbidity, and significant psychosocial and health consequences of these important psychiatric conditions.

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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Table 2. Screening Questionnaires for Eating Disorders

(Instructions: circle "Y" for "yes" and "N" for "no")

SCOFF Questionnaire (Morgan et al. 1999)

Y / N	Do you make yourself Sick because you feel uncomfortably full?
Y / N	Do you worry you have lost Control over how much you eat?
Y / N	Have you recently lost >14 lbs (One stone) in a 3-month period?
Y / N	Do you believe yourself to be Fat when others say you are too thin?
Y / N	Would you say that Food dominates your life?
Y / N	To assess for binge eating disorder, add: During the last 3 months, did you have any episodes of excessive overeating (i.e., eating significantly more than what most people would eat in a similar period of time)?

Screen for Disordered Eating (Maguen et al. 2018)

Y / N	Do you often feel the desire to eat when you are emotionally upset or stressed?
Y / N	Do you often feel that you can’t control what or how much you eat?
Y / N	Do you sometimes make yourself throw up (vomit) to control your weight?
Y / N	Are you often preoccupied with a desire to be thinner?
Y / N	Do you believe yourself to be fat when others say you are too thin?

Eating Disorder Screen for Primary Care (Cotton et al. 2003)

Y / N	Are you satisfied with your eating patterns? Answering “no” to this question is classified as an abnormal response.
Y / N	Do you ever eat in secret? Answering “yes” to this and all other questions is classified as an abnormal response.
Y / N	Does your weight affect the way you feel about yourself?
Y / N	Have any members of your family suffered with an eating disorder?
Y / N	Do you make yourself sick because you feel uncomfortably full?

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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