Monday, February 27, 2023
Apa releases revamped practice guideline on eating disorders.
APA has released an updated practice guideline on how to assess and treat patients with eating disorders —the first full update since 2006. The fourth edition of APA’s Practice Guideline for the Treatment of Patients With Eating Disorders reflects numerous new research findings since 2006 as well as diagnostic changes following the publication of DSM-5 in 2013 and DSM-5-TR in 2022.
“Eating disorders often are unrecognized and untreated,” noted Catherine Crone, M.D., chair of the practice guideline writing group, in an APA press release . “This guideline and supplementary resources are intended to serve as a practical tool for clinicians to help with screening, diagnosis, and providing evidence-based treatment for eating disorders.”
The updated guideline includes 16 clinical recommendations or suggestions related to anorexia nervosa, bulimia nervosa, and binge-eating disorder, including:
- Screening for the presence of an eating disorder as part of an initial psychiatric evaluation.
- Conducting comprehensive patient evaluations, including laboratory tests such as electrocardiograms.
- Formulating patient-centered and culturally sensitive treatment plans.
- Setting individualized weight goals for patients with anorexia.
- Treating patients with anorexia, bulimia, or binge-eating disorders with eating disorder–focused psychotherapy.
- Including family-based therapy as part of a treatment plan for adolescents with anorexia or bulimia.
The guideline also includes information on how to of evaluate patients for avoidant/restrictive food intake disorder (ARFID), which was added to DSM-5 ; however, due to limited clinical data, there are no specific recommendations for how to treat patients with ARFID.
To provide additional assistance to health professionals, APA has developed supplemental materials , such as a clinician pocket guide and an online course designed to introduce learners to concepts in the new guideline. Soon to be released are a guide for patients/families and an interactive clinical decision support tool.
“Early identification and treatment of an eating disorder is critical for achieving positive long-term outcomes,” said Joel Yager, M.D., a professor emeritus of psychiatry at the University of Colorado School of Medicine and the chair of the writing group for the three previous editions of the eating disorders practice guideline. “We hope that this tool will help anyone make an informed diagnosis regardless of their previous experience with eating disorders.”
To read more on this topic, see the Psychiatric News article “ Special Report: Youth With Eating Disorders—Time Is of the Essence in Achieving Remission .”
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Inclusion Criteria
Recommendation scope, screening for presence of an eating disorder, initial evaluation of eating history, quantitative measures, identification of co-occurring conditions, initial review of systems, initial laboratory assessment, initial electrocardiogram, treatment plan, including level of care.
- Quick-Reference Guide
- Quick-Reference Guide
- Patient Information
- Slide Set
Treatment of Patients with Eating Disorders
Statement 1
Statement 2.
- 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).
Statement 3
Statement 4, statement 5, initial physical examination, statement 6, statement 7, statement 8, statement 9, recommendation grading, authoring organization.
American Psychiatric Association
Publication Month/Year
July 18, 2022
Last Updated Month/Year
February 13, 2024
Supplemental Implementation Tools
Document type, country of publication.
Male, Female, Adolescent, Adult, Child, Older adult
Health Care Settings
Ambulatory, Hospital, Outpatient, School
Intended Users
Nurse, nurse practitioner, physician, physician assistant, psychologist
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
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.
Grading Table
COMMENTS
Anorexia Nervosa. 10. APA recommends(1C) that patients with anorexia nervosa who require nutritional rehabilitation and weight restoration have individualized goals set for weekly weight gain and target weight.. 11. APA recommends(1B) that adults with anorexia nervosa be treated with an eating disorder-focused psychotherapy, which should include normalizing eating and weight control behaviors ...
Eating disorders. An eating disorder is any disorder characterized primarily by a pathological disturbance of attitudes and behaviors related to food, including anorexia nervosa, bulimia nervosa, and binge-eating disorder. Other eating-related disorders include pica and rumination, which are usually diagnosed in infancy or early childhood.
eating disorders, as defined by the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5; American Psychiatric Association 2013). 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.
The American Psychiatric Association (APA) recently published an updated practice guideline for treatment of patients with eating disorders. The guideline provides recommendations on assessment and evidence-based pharmacological, psychotherapeutic, and other nonpharmacological treatments for eating disorders. The Practice Guideline for the Treatment of Patients with Eating Disorders focuses ...
According to a study by James Hudson, MD, ScD, and colleagues, 0.9 percent of women and 0.3 percent of U.S. men develop anorexia during their lifetime, while 1.5 percent of women and 0.5 percent of men develop bulimia ( Biological Psychology, 2007). Untreated, bulimia can lead to serious illnesses including gastrointestinal problems ...
The new tool strengthens clinicians' ability to screen for and treat patients with eating disorders. San Francisco — The American Psychiatric Association (APA), together with AvoMD, a software company that translates clinical evidence into the workflow, have developed an interactive screening and assessment tool for eating disorders based on the APA's new Practice Guideline for the ...
The lifetime prevalence of eating disorders in the United States is approximately 0.80% for anorexia nervosa, 0.28% for bulimia nervosa, and 0.85% for binge-eating disorder, although estimates can vary depending on the study location, sample demographic characteristics, case finding, and diagnostic approaches.
Eating disorders remain a significant concern in a culture where thinness is unduly emphasized, and where anorexia nervosa is the disorder with the highest premature fatality rate of any mental illness (Sullivan, 1995).Four out of five women in the United States are dissatisfied with their appearance (Smolak, 1996), and forty percent of Americans have experienced an eating disorder or know ...
In February 2023, APA published a new practice guideline for the treatment of eating disorders.² In this fourth edition of the guideline, the association stresses the seriousness of eating disorders and the lifetime challenges they cause. The guideline states: "The lifetime burdens and psychosocial impairments associated with an eating disorder can be substantial because these illnesses ...
In an article published in Behavioral Neuroscience (PDF, 133KB), Bergh et al. lend significant support to a new, effective approach. Using this approach, 75% of patients go into remission, on average, after 12.5 months of treatment, and only 10% relapse over 5 years of follow-up. In contrast, using standard care, less than 50% of patients are ...
THE AMERICAN PSYCHIATRIC ASSOCIATION PRACTICE GUIDELINE FOR THE TREATMENT OF PATIENTS WITH EATING DISORDERS FOURTH EDITION T ... APA Assembly Liaisons . Daniel Dahl, M.D. Evan Eyler, M.D. Jason W. Hunziker, M.D. ... Manufactured in the United States of America on acid-free paper 27262524 23 54321 . American Psychiatric Association 800 Maine ...
APA has released an updated practice guideline on how to assess and treat patients with eating disorders—the first full update since 2006. The fourth edition of APA's Practice Guideline for the Treatment of Patients With Eating Disorders reflects numerous new research findings since 2006 as well as diagnostic changes following the publication of DSM-5 in 2013 and DSM-5-TR in 2022.
The American Psychiatric Association (APA) has published a new practice guideline on the treatment of eating disorders, which appeared in the American Journal of Psychiatry. According to the ...
Statement 1 - APA recommends (1C) screening for the presence of an eating disorder as part of an initial psychiatric evaluation. • Prevalence rates have a wide range of estimates based on the study design and country. Rates for eating disorders that do not meet full diagnostic criteria are even higher.
The lifetime prevalence for all eating disorders worldwide is estimated to be 7.8%, according to a systematic review covering 2000-2018.(1) The total economic cost in the United States alone in 2018-2019 was estimated to be nearly $65 billion dollars.(2) These statistics are prior to the impact of the COVID-19 pandemic, which has been associated with a significant rise in the reported ...
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);
Eating disorders affect nearly 2% of Americans ... asking all adolescents about eating patterns and body image. The APA recommends screening as part of an initial psychiatric evaluation.
This book primarily benefits those who do not know a lot about eating disorders or who have not had any formal education with respect to the complexities of these disorders. It is a concise, accessible introduction to eating disorders for undergraduate and graduate students in psychology, as well as those specializing in health education and nutrition. Easy to read and grounded in definitions ...
The purpose of Clinical Manual of Eating Disorders is to provide a resource to help clinicians better understand how to care for patients and families seeking help (p.xix). This goal is masterfully achieved and exceeded at times. Well-organized and thorough discussions extend past the guidelines for the general management of anorexia nervosa ...
Print. Eating disorders are behavioral conditions characterized by severe and persistent disturbance in eating behaviors and associated distressing thoughts and emotions. They can be very serious conditions affecting physical, psychological and social function. Types of eating disorders include anorexia nervosa, bulimia nervosa, binge eating ...