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].
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