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APA Practice Guideline for the Treatment of Patients With Eating Disorders (3rd Ed)

APA Practice Guideline for the Treatment of Patients With Eating Disorders (3rd Ed)

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1
PRACTICE GUIDELINE FOR THE
 Treatment of PatientsWith Eating Disorders
 Third Edition
WORK GROUP ON EATING DISORDERS
 Joel Yager, M.D., ChairMichael J. Devlin, M.D.Katherine A. Halmi, M.D.David B. Herzog, M.D. James E. Mitchell III, M.D.Pauline Powers, M.D.Kathryn J. Zerbe, M.D.
This practice guideline was approved in December 2005 and published in June 2006. A guideline watch, summarizing significant developments in the scientific literature since publication of this guideline, may be available inthe Psychiatric Practice section of the APA web site at www.psych.org.
 
AMERICAN PSYCHIATRIC ASSOCIATIONSTEERING COMMITTEE ON PRACTICE GUIDELINES
 John S. McIntyre, M.D.,
Chair 
Sara C. Charles, M.D.,
Vice-Chair 
Daniel J. Anzia, M.D.Ian A. Cook, M.D.Molly T. Finnerty, M.D.Bradley R. Johnson, M.D. James E. Nininger, M.D.Paul Summergrad, M.D.Sherwyn M. Woods, M.D., Ph.D. Joel Yager, M.D.
AREA AND COMPONENT LIAISONS
Robert Pyles, M.D. (Area I)C. Deborah Cross, M.D. (Area II)Roger Peele, M.D. (Area III)Daniel J. Anzia, M.D. (Area IV) John P. D. Shemo, M.D. (Area V)Lawrence Lurie, M.D. (Area VI)R. Dale Walker, M.D. (Area VII)Mary Ann Barnovitz, M.D.Sheila Hafter Gray, M.D.Sunil Saxena, M.D.Tina Tonnu, M.D.
STAFF
Robert Kunkle, M.A.,
Senior Program Manager 
 Amy B. Albert, B.A.,
 Assistant Project Manager 
Laura J. Fochtmann, M.D.,
 Medical Editor 
Claudia Hart,
Director, Department of Quality Improvement and Psychiatric Services 
Darrel A. Regier, M.D., M.P.H.,
Director, Division of Research
 
Treatment of Patients With Eating Disorders 
3
CONTENTS
Statement of Intent. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Guide to Using This Practice Guideline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Development Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Part A: Treatment Recommendations for Patients With Eating Disorders . . . . . . . . . . . .11
I.Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11A.Coding System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11B.Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11II.Formulation and Implementation of a Treatment Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22A.Psychiatric Management. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22B.Developing a Treatment Plan for the Individual Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . 35III.Clinical Features Influencing the Treatment Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57A.Chronicity of Eating Disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57B.Other Psychiatric Factors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58C.Concurrent General Medical Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60D.Demographic Variables. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Part B: Background Information and Review of Available Evidence . . . . . . . . . . . . . . . .66
IV.Disease Definition, Epidemiology, and Natural History. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66A.Disease Definition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66B.Epidemiology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69C.Natural History and Course. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70D.Genetic Factors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73V.Review and Synthesis of Available Evidence. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74A.Treatment of Anorexia Nervosa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75B.Treatment of Bulimia Nervosa. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81C.Treatment of Binge Eating Disorder. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Part C: Future Research Needs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .87
Individuals and Organizations That Submitted Comments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91

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