The recently released new eating disorders treatment guideline issued by the American Psychiatric Association (APA) provides suggested approaches to treating patients with eating disorders.
The American Psychiatric Association Practice Guideline for the Treatment of Patients With Eating Disorders(https://psychiatryonline.org/doi/10.1176/appi.books.9780890424865), 4th edition, replaces guidelines not revised for some time, and the new edition is welcome. These can impact coverage decisions by payors and, presumably, treatment decisions by treatment providers, so they are of importance to the field. The guideline writing group was headed by chairman Catherine Crone, MD, and colleagues (Am J Psychiatry. 2023. 180:167).
The new recommendations begin with the suggestions for the physical examination, including assessing vital signs, including temperature, blood pressure, orthostatic pulse, and orthostatic blood pressure.
The APA breaks down the approach for anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED), noting that the many studies of eating disorders they evaluated neither examined data separately for subgroups nor excluded patients with comorbidities. The new guideline emphasizes culturally appropriate and person-centered treatment plans, including medical, psychiatric, psychological, and nutritional expertise, ideally using a multidisciplinary team.
For AN:
Adults: the guideline recommends eating disorder-focused psychotherapy aimed at normalizing eating and weight maintenance, restoring weight, and addressing psychological factors such as fear of gaining weight and body dysmorphia. For adolescents and emerging adults, the APA recommended family-based approach and caregiver education focused on normalizing eating and weight maintenance eating and weight maintenance as well as weight restoration.
For BN:
Adults: the APA recommends starting treatment with eating-disorder-focused cognitive behavioral therapy, or CBT. In addition, the APA recommends prescribing a serotonin reuptake inhibitor, such as fluoxetine, 60 mg daily, if the patient prefers medication, or when there is little to no response to psychotherapy alone by 6 weeks. For adolescents and emerging adults: eating disorders-focused family-based treatment is recommended for those who have an involved caregiver.
For BED:
For adults and adolescents with BED, the guideline points to individual or group-based eating disorder-focused cognitive behavioral therapy, or CBT, or interpersonal therapy. Antidepressant medication, or lisdexamfetamine, is suggested for adult patients with BED who either prefer medication or who have not responded to psychotherapy alone.
The guidelines also include ethical issues in the treatment of eating disorders, as well as a listing of Internet resources, and suggested books for patients and their families. These guidelines will likely influence several aspects of eating disorder treatment in the coming years.
