Eating disorders
Also known as: anorexia nervosa · ARFID · binge eating disorder · bulimia nervosa
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The American Psychiatric Association Practice Guideline for the Treatment of Patients With Eating Disorders
American Psychiatric Association (APA) · 2023 · 4th edition (2023)
The APA's current guideline on eating disorders, the first full revision since 2006. It focuses on assessment and on evidence-based pharmacological, psychotherapeutic and other non-pharmacological treatment for adolescents and adults, principally anorexia nervosa, bulimia nervosa and binge-eating disorder, and begins with screening as part of the initial psychiatric evaluation. Linked via the PubMed record for the executive summary because the publisher's pages block automated access.
- Fourth edition; executive summary published in Am J Psychiatry 2023;180(2):167-171. source
- Focuses primarily on anorexia nervosa, bulimia nervosa and binge-eating disorder in adolescents and adults. source
- Led by Catherine Crone with an APA writing group; classified by PubMed as a practice guideline. source
Eating disorders: recognition and treatment
NICE (UK) · 2017 · NG69
UK national guidance on assessing, diagnosing, treating and monitoring eating disorders in children, young people and adults, including inpatient care. It covers anorexia nervosa, bulimia nervosa, binge eating disorder and other specified feeding or eating disorder, and excludes ARFID, pica and rumination disorder. Published 2017, last updated December 2020, with a presentational tidy-up in 2024.
US vs EU key differences
- The two agree on adolescent anorexia: both put eating-disorder-focused family-based treatment first where a caregiver is involved (NICE calls it anorexia-nervosa-focused family therapy). source
- Adult anorexia treatment is specified differently: NICE names three manualised options (individual CBT-ED, MANTRA or specialist supportive clinical management), while the American Psychiatric Association guideline centres on monitored renourishment plus eating-disorder-focused psychotherapy with explicit weight targets such as a BMI around 20 in adults. source
- Medication use diverges for bulimia: the US guideline recommends eating-disorder-focused CBT combined with fluoxetine 60 mg daily, whereas NICE starts with bulimia-focused guided self-help and states that medication should not be offered as the sole treatment. source
- For binge-eating disorder the US guideline recommends CBT or interpersonal psychotherapy with an antidepressant or lisdexamfetamine when pharmacotherapy is indicated, while NICE begins with a binge-eating-disorder-focused guided self-help programme before group or individual CBT. source
- Currency differs: the American Psychiatric Association guideline was published in 2023 as the first full revision since 2006, with 16 recommendations, while NICE NG69 dates to 2017. source
What changed recently
- US3rd edition (2006) → 4th edition (2023)2023-02-01
The fourth edition is the first revision since 2006 and condenses guidance into 16 graded recommendations covering anorexia nervosa, bulimia nervosa and binge-eating disorder. New elements include routine screening for eating disorders during initial psychiatric evaluation, individualised weight goals in anorexia, eating-disorder-focused psychotherapy as the core treatment, and family-based therapy for adolescents; avoidant/restrictive food intake disorder is discussed but left without recommendations for lack of trial data.
source ↗curation confidence 90% - EUCG9 (2004) → NG692017-05-23
NG69 updates and replaces the 2004 CG9 guideline on the back of a much larger evidence base, naming specific psychological therapies rather than the largely non-specific advice of 2004. For adults with anorexia nervosa it offers a choice of eating-disorder-focused CBT, MANTRA or specialist supportive clinical management, and CBT-ED becomes the recommended treatment for bulimia nervosa, binge-eating disorder and OSFED.
source ↗curation confidence 90%
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