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Clinical Guidelines on Eating Disorders: A Practical Tool for Trainees and Clinicians Alike

  • February 27, 2023

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 frequency of eating disorders, particularly among adolescents and young adults.

Given the prevalence and impact of eating disorders, it is essential for psychiatrists and other mental health professionals to be able to assess and treat them. Unfortunately, during medical school and residency, it is much less likely for trainees to obtain substantial education and clinical experience in the diagnosis and care of patients with eating disorders compared to patients with mood or anxiety disorders. Experience with eating disorders is also limited among clinicians working in other specialties. As a result, eating disorders often are unrecognized and patients do not receive timely and appropriate treatment.

The need to help clinicians with screening, diagnosis, and providing evidence-based treatment for eating disorders led to the development of the revised APA Practice Guideline for the Treatment of Patients with Eating Disorders. The guideline is intended to serve as a practical tool for clinicians. It distills current evidence and incorporates expert-based consensus where gaps in the research evidence are present. Within this revision, 16 guideline statements cover:

  • Screening for eating disorders during an initial psychiatric evaluation.
  • Psychological, physical, and laboratory assessments of a patient with a suspected eating disorder.
  • Psychotherapeutic and pharmacologic treatment approaches for anorexia nervosa, bulimia nervosa, and binge eating disorder.

The guideline includes detailed and clearly written implementation information that provides additional instruction on how to apply each guideline statement in practice. New and growing areas of concern that have limited evidence to date, such as avoidant/restrictive food intake disorder (ARFID), are discussed. The guideline also includes comprehensive tables with details about physical signs and symptoms of eating disorders, associated laboratory abnormalities, and specific guidance about levels of care including types of care settings and decisions about levels of care.

We hope this guideline helps clinicians better treat patients with eating disorders and improves the lives of the millions of individuals who have these disorders.

Eating Disorder Guideline Resources

  • Executive Summary of the Eating Disorders Practice Guideline (published in the American Journal of Psychiatry)
  • Pocket Guide for Clinicians - includes the guideline recommendations, lists of screening and assessment tools, description of treatment options, and an algorithm. Available in online (e-flipbook - free) and printed copy (for purchase).
  • Summary/Training Slides (.pptx) - provide a summary of the practice guidelines that can be used as a training tool. (PowerPoint presentation)
  • CME Learning Activity - with webinar and case vignettes. Available through the APA Learning Center.
  • Interactive Toolkit – (Coming soon) provides practical, credible guidance to psychiatrists, pediatricians, primary care, and other healthcare professionals to support screening, assessment, and management plans for potential eating disorder patients. Includes
    • Screening assessment calculator.
    • Quantitative assessments (for use after patients screen positive).
    • Diagnostic criteria and management recommendations (for use by psychiatrists or other eating disorder experts).
  • Summary Guide for Patients and Families (Coming soon).

By
Catherine Crone, M.D.
Chair, Eating Disorders Guideline Writing Group

Laura J. Fochtmann, M.D., M.B.I.
Vice-Chair and Methodologist, Eating Disorders Guideline Writing Group

References

1. Galmiche, M., Déchelotte, P., Lambert, G., & Tavolacci, M. P. (2019). Prevalence of eating disorders over the 2000-2018 period: a systematic literature review. The American journal of clinical nutrition, 109(5), 1402–1413. https://doi.org/10.1093/ajcn/nqy342

2. Streatfeild, J., Hickson, J., Austin, S. B., et al. (2021). Social and economic cost of eating disorders in the United States: Evidence to inform policy action. The International journal of eating disorders, 54(5), 851–868. https://doi.org/10.1002/eat.23486

Author

Catherine Crone, M.D.

Chair, Eating Disorders Guideline Writing Group

Author

Laura J. Fochtmann, M.D., M.B.I.

Vice-Chair and Methodologist, Eating Disorders Guideline Writing Group

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