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TREATING EATING DISORDERSA Quick Reference Guide

DOI: 10.1176/appi.books.9780890423370.146925
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Based on Practice Guideline for the Treatment of Patients With Eating Disorders, Third Edition, originally published in July 2006. A guideline watch, summarizing significant developments in the scientific literature since publication of this guideline, may be available.

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Table Reference Number
TABLE 1. Laboratory Assessments for Patients With Eating Disorders
Table Reference Number
TABLE 2. Physical Complications of Eating Disorders
Table Reference Number

Adults

Children and Adolescents

  • Generally, weight <85% of individually estimated healthy body weight

  • Heart rate <40 bpm

  • Blood pressure <90/60 mm Hg

  • Glucose <60 mg/dL

  • Potassium <3 mEq/L

  • Electrolyte imbalance

  • Temperature <97.0°F

  • Dehydration

  • Hepatic, renal, or cardiovascular organ compromise requiring acute treatment

  • Poorly controlled diabetes

  • Generally, weight <85% of individually estimated healthy body weight or acute weight decline with food refusal

  • Heart rate near 40 bpm

  • Orthostatic hypotension (with an increase in pulse of >20 bpm or a drop in blood pressure of >10–20 mm Hg/minute from supine to standing

  • Blood pressure <80/50 mm Hg

  • Hypokalemia, hypophosphatemia, or hypomagnesemia

Table Reference Number

Therapy

Indication/Notes

Individual psychotherapy

Is usually required for at least 1 year and may take many years because of the enduring nature of the illness and the need for support during recovery.

Cognitive-behavioral, interpersonal, and psychodynamic approaches—or a combination of these approaches—have the most evidence and consensus for use in adults.

Family and couples therapy

Is useful when family or marital problems are contributing to the maintenance of the disorder.

Family approaches are most effective with children and adolescents, particularly with illnesses lasting less than 3 years.

Group psychotherapy

Typically has a cognitive-behavioral, interpersonal, and/or psychodynamic focus.

Care must be taken to help patients avoid competition to be the thinnest or the sickest and cope with demoralization from observation of the difficult, chronic course of the illness.

Self-help, online resources, 12-step models

Can be helpful adjuncts for some and patients.

Lack of professional supervision can sometimes perpetuate misinformation or unhealthy dynamics.

Table Reference Number

Therapy

Indications/Notes

Individual psychotherapy

Cognitive-behavioral therapy

Is effective as a short-term intervention when specifically directed at eating disorder symptoms and underlying maladaptive cognitions.

Is useful in reducing binge eating symptoms and improving attitudes about shape, weight, and restrictive dieting.

Interpersonal psychotherapy

May also be helpful.

Psychodynamically oriented and psychoanalytic approaches

May also be helpful.

Behavioral techniques (e.g., planned meals, self-monitoring)

May also be helpful.

Group psychotherapy

May be based on cognitive-behavioral, interpersonal, psychodynamic, and/or supportive models.

Can help the patient with shame surrounding the disorder.

Provides peer-based feedback and support.

Is more useful if dietary counseling and management are included in the program.

Family and couples therapy

Should be considered especially for adolescents who live with parents, for older patients with ongoing conflicted interaction with parents, or for patients with marital discord.

Self-help, online resources, and 12-step models

Can be helpful adjuncts for some patients.

Lack of professional supervision can sometimes perpetuate misinformation or unhealthy dynamics among users.

Table Reference Number

Class

Notes

SSRIs

Have the most evidence for efficacy and the fewest difficulties with adverse effects.

Helpful for depression, anxiety, obsessions, certain impulse disorder symptoms, and for those patients with a suboptimal response to appropriate psychosocial therapy.

Fluoxetine is the only medication currently approved by the FDA for bulimia nervosa.

Dosages may need to be higher than those used to treat depression (e.g., 60–80 mg/day of fluoxetine).

Typical side effects include insomnia, nausea, asthenia, sexual side effects.

TCAs

Should generally be avoided, and their potential lethality and toxicity in overdose should be taken into consideration.

MAOIs

Should be avoided for patients with chaotic binge eating and purging.

Bupropion

Should be avoided in patients with bulimia because of increased seizure risk.

References

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