Anorexia Nervosa Guidelines

Updated: Apr 14, 2023
  • Author: Bettina E Bernstein, DO; Chief Editor: Caroly Pataki, MD  more...
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Guidelines

Guidelines Summary

American Psychiatric Association

The American Psychiatric Association (APA) published guidelines for the treatment of eating disorders in February 2023. [132, 133] The guidelines recommend that screening for the presence of an eating disorder should be part of an initial psychiatric evaluation. The initial evaluation of a patient with a possible eating disorder should include assessment of multiple factors, including but not limited to, patient’s history of height and weight, eating-related behaviors, food repertoire, weight control behaviors, and family history. The evaluation should also identify co-occurring health conditions and psychiatric disorders.

Patients with anorexia nervosa (AN) who require nutritional rehabilitation and weight restoration should have individualized goals for weekly weight gain and target weight. Adults with AN should be treated with an eating disorder-focused psychotherapy.

The Royal Australian and New Zealand College of Psychiatrists

The Royal Australian and New Zealand College of Psychiatrists released the first set of eating disorder guidelines that incorporate recommendations from the DSM-5. The guidelines focus on anorexia nervosa, but also cover bulimia nervosa, binge eating disorder, and the new disorder of avoidant-restrictive food intake disorder. [134]

Recommendations include the following:

  • Most patients with anorexia nervosa should be treated as outpatients or day patients.

  • A multi-disciplinary treatment approach incorporating consideration of nutritional, medical and psychological aspects, family-based therapies in younger patients, and specialist therapist-led manual-based psychological therapy with long-term follow-up in all age groups should be used.

  • In chronic anorexia nervosa, a harm minimization approach should be used.

  • The approach to diagnosis and treatment should be culturally informed.

Canadian practice guidelines

Canadian practice guidelines for treating children and adolescents with eating disorders were published in 2020. [135] Recommendations include the following:

  • Family-based treatment (FBT) is strongly recommended for children and adolescents with anorexia nervosa or bulimia nervosa.

  • Multi-family therapy (MFT) is a reasonable treatment option for children and adolescents with anorexia nervosa.

  • Cognitive-behavioral therapy (CBT) is a reasonable treatment option for children and adolescents with anorexia nervosa or bulimia nervosa.

  • Adolescent-focused therapy (AFP) is a reasonable treatment option for children and adolescents with anorexia nervosa.

  • Yoga, in addition to standard treatments, is a reasonable treatment option for medically stable children and adolescents with anorexia nervosa, bulimia nervosa, and other specified feeding and eating disorders.

  • Olanzapine or aripiprazole may be reasonable treatment options for certain populations of children and adolescents with anorexia nervosa if monitored carefully.

  • It is strongly recommended that the least intensive treatment environment be provided, especially for those children and adolescents with anorexia nervosa requiring a first admission to hospital and/or with a duration of illness less than 3 years.