APA releases new guidelines for assessment, treatment of eating disorders

The American Psychiatric Association plans to align treatment of eating disorders with a focus on risk-benefit analysis of physical and psychosocial factors, according to new guidelines published in the American Journal of Psychiatry.

“Since publication of the last American Psychiatric Association practice guideline on eating disorders, there have been many studies on psychotherapies for individuals with these diagnoses as well as some studies on pharmacotherapies,” Catherine Crone, MD, chair of the APA Practice Guideline Writing Group, and colleagues wrote.

Authors of the updated guidelines — which were approved at the APA’s April 2021 meeting — stipulated both the overall patient health assessment and determination of any treatment plan for a specific disorder be directed by twin ratings: a numeric recommendation (1, 2) that indicates a level of confidence that the benefits of a particular intervention outweigh the harms, and an alphabetic rating (A, B, C) to determine the relative strength of research evidence to guide each intervention.

In the report, the APA codified nine recommendations for patient assessment and treatment plan determination, centering on initial screening for potential signs of an eating disorder during an initial psychiatric evaluation.

Considerations included the patient’s height, weight, fluctuations of the latter, patterns of eating or avoidance of such, including hiding food or expectorating, adding or elimination of food groups or specific foods, behaviors related to binging and purging, use of medication to manipulate weight, amount of time spent ruminating about or acting on perceived flaws in body shape, any response to previous treatment for an eating disorder and family history of illnesses related to eating disorders and other co-related medical conditions.

Further recommendations suggest that psychiatric evaluations of a patient also include basic physical and physiological examinations, bloodwork, complete metabolic panel and ECG as well as additional examinations and treatment that is individual-centered and culturally appropriate, accomplished by experts across several disciplines.

The new guidelines offer specific recommendations for three specific eating disorders: anorexia nervosa, bulimia nervosa and binge-eating disorder.

Regarding anorexia, current recommendations suggest that all patients be able to set personalized goals for weight gain and target weight. Specific to age range, the guidelines stipulate that adolescents and younger adults who have a caregiver involved should seek family-based disorder education, while adults should seek therapy based around psychological aspects of weight gain.

For young persons who are dealing with bulimia and have caregiver involvement, the new guidelines also suggest family-based disorder treatment. Adults with the disorder are advised to engage in cognitive behavioral therapy with prescribed serotonin reuptake inhibitors either at treatment outset or due to a lack of response to psychotherapy alone at 6 weeks.

New APA recommendations surrounding binge-eating disorders suggest treatment with disorder-based CBT either individually or in a group, while adults who choose medication are specifically advised to seek treatment with antidepressants or lisdexamfetamine if they are unable to respond to psychotherapy alone.

“In the absence of more robust evidence, the statements in this guideline should generally be applicable to individuals with co-occurring conditions,” Crone and colleagues wrote.