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NEDA TOOLKIT for Parents Practice guideline for the treatment of patients with eating disorders Brief Summary Bibliographic Sources American Psychiatric Association (APA). Practice guideline for the treatment of patients with eating disorders. 3rd ed. Washington (DC): American Psychiatric Association (APA); 2006 Jun. 128 p. [765 references] American Psychiatric Association. Treatment of patients with eating disorders, third edition. Am J Psychiatry 2006 Jul;163(7 Suppl):4-54. PubMed Major Recommendations Each recommendation is identified as meriting one of three categories of endorsement, based on the level of clinical confidence regarding the recommendation, as indicated by a bracketed Roman numeral after the statement. Definitions of the categories of endorsement are presented at the end of the “Major Recommendations” field. 1. Psychiatric Management Psychiatric management begins with the establishment of a therapeutic alliance, which is enhanced by empathic comments and behaviors, positive regard, reassurance, and support [I]. Basic psychiatric management includes support through the provision of educational materials, including self-help workbooks; information on community-based and Internet resources; and direct advice to patients and their families (if they are involved) [I]. A team approach is the recommended model of care [I]. a. Coordinating Care and Collaborating with Other Clinicians In treating adults with eating disorders, the psychiatrist may assume the leadership role within a program or team that includes other physicians, psychologists, registered dietitians, and social workers or may work collaboratively on a team led by others. For the management of acute and ongoing medical and dental complications, it is important that psychiatrists consult other physician specialists and dentists [I]. When a patient is managed by an interdisciplinary team in an outpatient setting, communication among the professionals is essential to monitoring the patient’s progress, making necessary adjustments to the treatment plan, and delineating the specific roles and tasks of each team member [I]. b. Assessing and Monitoring Eating Disorder Symptoms and Behaviors A careful assessment of the patient’s history, symptoms, behaviors, and mental status is the first step in making a diagnosis of an eating disorder [I]. The complete assessment usually requires at least several hours and includes a thorough review of the patient’s height and weight history; restrictive and binge eating and exercise patterns and their changes; purging and other compensatory behaviors; core attitudes regarding weight, shape, and eating; and associated psychiatric conditions [I]. A family history of eating disorders or other psychiatric disorders, including alcohol and other substance use disorders; a family history of obesity; family interactions in relation to the patient’s disorder; and family attitudes toward eating, exercise, and appearance are all relevant to the assessment [I]. A clinician’s articulation of theories that imply blame or permit family members to blame one another or themselves can alienate family members from involvement in the treatment and therefore be detrimental to the patient’s care and recovery [I]. It is important to identify family stressors whose amelioration may facilitate recovery [I]. In the assessment of children and adolescents, it is essential to involve parents and, whenever appropriate, school personnel and health professionals who routinely work with the patient [I]. Page | 44