Lifelong Learning: The American Psychiatric Association Practice Guideline for the Treatment of Patients With Eating Disorders-View Article

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The American Psychiatric Association (APA) has released updated guidelines for treating eating disorders, approved in April 2021. These guidelines aim to improve the quality of care and treatment outcomes for patients classified under the DSM-5-TR criteria. Despite recent research in psychotherapies and pharmacotherapies, gaps in evidence-based treatments for eating disorders persist.<br /><br />Eating disorders such as anorexia nervosa (0.80% prevalence), bulimia nervosa (0.28%), and binge-eating disorder (0.85%) have considerable psychosocial and health impacts, including high mortality and suicide rates. These conditions often coexist with psychiatric disorders like depression, anxiety, and substance use disorders, and can lead to severe physical health issues.<br /><br />The guideline development process adhered to established standards, emphasizing systematic reviews and evidence evaluation. It includes strong recommendations, especially for initial evaluations involving comprehensive assessments of eating and weight control behaviors, co-occurring health conditions, and socio-cultural factors.<br /><br />Key treatment recommendations include:<br />1. Anorexia nervosa patients need individualized nutritional rehabilitation and weight restoration goals. Adults should receive psychotherapy focusing on normalizing behaviors and addressing psychological issues, while adolescents should engage in family-based treatment.<br />2. For bulimia nervosa, a combination of cognitive-behavioral therapy and serotonin reuptake inhibitors is advised, with family-based treatment for adolescents.<br />3. Binge-eating disorder therapy should focus on cognitive-behavioral or interpersonal therapy, with medication considered if psychotherapy alone is ineffective.<br /><br />The guidelines recognize limitations in high-quality evidence due to the complex nature of eating disorders, compounded by individual patient differences. Although the guidelines provide a robust framework for treatment, individual clinical judgment and patient preferences remain crucial in decision-making. The economic impact, amounting to billions annually in the U.S., underscores the importance of effective management strategies for these disorders.

Keywords

American Psychiatric Association

eating disorders

DSM-5-TR

anorexia nervosa

bulimia nervosa

binge-eating disorder

psychotherapy

pharmacotherapy

treatment guidelines

mental health