Eating Disorders

Early Identification/Initial Screening

Early Identification is key. PCPs are in a unique position to detect disordered eating early and interrupt their progression (Hornberger et al, 2021).

All disordered eating is not an eating disorder.

“Disordered eating” refers to a spectrum of problematic eating behaviors and distorted attitudes towards food, weight, shape, and appearance. Disordered eating patterns can vary in severity but do not meet the frequency, duration and/or psychological criteria for a diagnosable eating disorder. Identifying and early intervention can prevent progression to a more serious disorder.

Screen during routine visits or other symptom related appointments

Red Flags

• Physical
  • Falling off Growth Curve or fluctuations in weight
  • Cardiovascular: Dizziness or syncope, orthostatic changes, bradycardia
  • Cold intolerance
  • Amenorrhea
• Behavioral
  • Rigidity around food, meal avoidance
  • Cutting food into tiny pieces and decreased intake
  • Excessive exercise
  • Social withdrawal
  • Change in attire or appearance
• Cognitive
  • Intense fear of weight gain
  • Distorted body image
  • Perfectionism
  • Rigid, black and white thinking, especially around food or health
• Family
  • Increasing mealtime conflict
  • Hidden food
  • Parental concerns about sudden behavioral changes
  • Food or body focused screen use

Screening tools (Use when disordered eating is suspected)

(Helpful but not diagnostic, significant false negative or positive and do not include screening questions for ARFID)

ESP-PC (Eating Disorder Screen for Primary Care)
https://pmc.ncbi.nlm.nih.gov/articles/PMC1494802/

1. Are you satisfied with your eating patterns?
   (A “no” to this question is classified as an abnormal response).
2. Do you ever eat in secret?
   (A “yes” to this and all other questions are classified as an abnormal response).
3. Does your weight affect the way you feel about yourself?
4. Have any members of your family suffered with an eating disorder?
5. Do you currently suffer with or have you ever suffered in the past with an eating disorder?

SCOFF:

SCOFF Questionnaire 

SDE (Screen for Disordered Eating) 5 item screen:

https://www.nyeatingdisorders.org/_assets/pdf/screen_for_disordered_eating.pdf

BRIGHT FUTURES – Eating Disorders Screening Questions

https://www.brightfutures.org/mentalhealth/pdf/bridges/eat_disorder.pdfa

Goals of Assessment and Treatment

Primary Care Providers are often the first clinicians to detect disordered eating. Diagnosis and early intervention can significantly improve patient outcome. In addition to diagnosis, immediate medical priorities include determining the level of care, establishing an initial Target Goal Weight, assessing for medical stability and the possible need for emergency intervention (see criteria below).

• Establish Diagnosis
  • Identify possible alterative diagnoses and comorbid conditions
• Assess nutritional and metabolic conditions and establish a Target Treatment Weight goal, utilizing anthropomorphic measures and trends over time
• Assess motivation for change and family engagement
• Recommend and refer for appropriate treatment and level of care

IS THERE A NEED FOR URGENT ASSESMENT/HOSPTALIZATION?

*** An Immediate medical priority is to evaluate the medical stability and safety risk to determine if urgent referral for ED to a hospital may be required.

Suggested Criteria:

One or more of the following justify referral for urgent assessment and hospitalization:

1. 75% median body mass index for age and sex (Adults BMI<15)
2. Dehydration
3. Electrolyte disturbance
   (K<3.0mEq/L, Na<130mEq/L, Phos<2.0mg/dL, Mg<1.5mg/dL, Glucose<60 mg/dl)
4. EKG abnormalities (e.g., prolonged QTc or severe bradycardia or other arrythmia)
5. Physiological instability
   • Severe Bradycardia
     (<50 beats/minute (at daytime. <45 beats/minute at night)
   • Hypotension (<90/45 mm Hg)
   • Hypothermia (body temperature <96 F, 35.6 C)
   • Orthostatic increase in pulse (>20 beats per minute) or decrease in blood pressure.
     (>20 mm Hg systolic or >10 mm Hg diastolic)
6. Arrested growth and development
7. Failure of outpatient treatment
8. Acute food refusal
9. Uncontrollable bingeing and purging
10. Acute medical complications of malnutrition (e.g., syncope, seizures, cardiac failure, pancreatitis, etc.)
11. Significant Suicide Risk or other comorbid psychiatric or medical condition that prohibits or limits appropriate outpatient treatment (e.g., severe depression, suicidal ideation, obsessive compulsive disorder, type 1 diabetes mellitus)
    *From: Golden et al, 2015

Additional Considerations:

• > 10% loss of Body Massin 6 months or >20% Loss over 12 months
• Hypothermia (Body temp<36 degrees C)

History

Review psychosocial history including:

• Weight history (loss, gain, fluctuations)
• Body image, general, dysmorphia?
• History of dieting, use of diuretics, laxatives, supplements, steroids
• Eating patterns (dieting, weight control behaviors, binging, purging, fasting, skipping meals)
• Cognitive symptoms: fear of weight gain, fat, distorted body image, perfectionism
• Exercise: excessive exercise, purpose, change
• Menstrual pattern: menarche, MP, amenorrhea?
• Other review of symptoms
  • Dizziness, syncope, weakness or fatigue
  • Pallor, cold intolerance or bruising
  • Hair (loss, lanugo) or skin changes
  • GI: constipation, diarrhea, fullness or bloating
• Psychosocial history- including but not limited to:
  • Mood issues or changes (anxiety, compulsions, depression)
  • Suicidality, self-injury thoughts or behavior
  • History of trauma or abuse
  • Family- History of mental health issues, stressors, conflict, meal patterns
  • Academic, social and extracurricular activities
  • Internet and app use, esp. related to body and eating issues.
  • Menstrual and Sexual history
    (e.g., menarche, last menstrual period, regularity)
    • Oral contraceptive use-oral contraceptive use may be masking the impact of eating disorder on menstrual status)
  • Substance use (including nicotine, vapes, energy drinks, steroids)
  • Previous history of mental health diagnosis or treatment
  • Medication history
    • Current medications and supplements
    • Past medications and supplements

Physical Assessment

• Measurement of height, weight, and determination of body mass index; record weight, height and BMI on growth charts for children and adolescents (if appropriate)-show sensitivity and provide the option to blind weigh
• Sitting and orthostatic heart rate and blood pressure 
• Body temperature
• Hydration status (e.g., poor skin turgor, slow capillary return)
• Assessment of skin, hair and nails (e.g., brittle nails, carotenaemia [orange discoloration], dry skin, lanugo hair, callused knuckles) 
• Oral examination (e.g., dental erosions, gingivitis, pharyngeal redness and parotid enlargement)
• Assessment of breathing and breath (e.g., ketosis) 
• Examination of peripheral circulation and edema
• Gastrointestinal function (e.g., bloating, pain, constipation, diarrhea)
• Mental Status including safety and suicide risk assessment

Estimating Severity of Malnutrition/Determining Target Goal Weight

(from Golden et al, 2015)

• A critical early task of the pediatrician is to identify a treatment goal weight. This goal weight may be determined in collaboration with a registered dietitian. PCPs who are planning to refer the patient to a specialized treatment team may opt to defer the task to the team.
• For adolescents, individual’s treatment goal weight range should consider the premorbid trajectory for height, weight, and BMI, age at pubertal onset, and current pubertal stage.
• A two-step process is helpful as follows:
  1. Determination of the degree of malnutrition compared with the reference population using percent median BMI and z scores as described previously, and then…
  2. Determining a healthy weight range for that individual, based on previous the individual’s previous height, weight, BMI percentiles, pubertal stage, and growth trajectory. Treatment goal weight for a particular patient cannot simply be read off the charts based on normative population data. Put another way, treatment goal weight is not necessarily the same as the weight associated with median BMI.

A proposed classification of the degree of malnutrition for adolescents with eating disorders:

	Mild	Moderate	Severe
% Median BMI	80-90%	70-79%	<70%
MBI z score	-1 to-1.9	-2 to -2.9	– 3 or more
Weight Loss	>10% Body mass loss	>15% Body Mass loss	20% body mass loss in 1 year  Or >10% loss in 6 months

Golden et al, 2015
CDC Growth Charts: https://www.cdc.gov/growthcharts/
CDC BMI Charts: https://www.cdc.gov/growthcharts/Extended-BMI-Charts.html

Laboratory and Other Assessments

(for complications and differential diagnosis)

Primary Care Providers are crucial in evaluating medical stability and determining the urgency of treatment for patients with eating disorders.

• Assess for medical instability: Assess vital signs, orthostatic measurements, EKG, electrolytes, and hydration status to evaluate medical risk. (See Hospitalization Criteria above)
• Core Medical Stability Labs
  Laboratory assessments help identify dehydration, electrolyte shifts, organ stress, and complications from purging or restriction.
  • CBC with Diff: Neutropenia, thrombocytopenia, and bone marrow suppression.
  • CMP: Evaluates electrolytes, renal function, liver enzymes, and glucose.
  • Magnesium and phosphorus: Critical for identifying risk of refeeding syndrome and purging-related losses.
  • Consider the possibility of reactive hypoglycemia due to depletion of glycogen storage. Asymptomatic hypoglycemia is associated with sudden death in anorexia nervosa.
• Purging‑Related Labs
  • These tests detect salivary gland stress, pancreatic irritation, and metabolic alkalosis.
  • Amylase and Lipase: Elevated amylase can indicate vomiting; lipase is useful to rule out pancreatitis.
  • Serum Bicarbonate (part of CMP): Metabolic alkalosis may suggest vomiting; metabolic acidosis may indicate laxative abuse.
• Nutritional Deficiency Labs
  • These tests reveal common deficiencies in restrictive eating disorders and inform ongoing medical monitoring.
  • Iron studies (Iron, TIBC, Ferritin): Screens for iron deficiency or anemia of chronic disease.
  • Vitamin B12 level: Identifies deficiency that may contribute to fatigue, neuropathy, or cognitive symptoms.
  • Zinc level: Low zinc is common in restrictive EDs and can worsen appetite and taste perception.
  • Vitamin D level: Important for bone health, especially in amenorrhea or low-weight states.
• Medical Mimics and Comorbid Conditions
  • These tests help rule out conditions that can present weight loss, gastrointestinal symptoms, or changes in appetite.
  • Celiac panel (tTG‑IgA and total IgA): Screens for malabsorption and autoimmune GI disease.
  • TSH and free T4: Screens for thyroid disease that can mimic or complicate eating disorder symptoms.
  • Estradiol, FSH, LH, Testosterone based on history.
• Other tests
  • Urine Analysis with specific gravity: High suggests dehydration, low suggests patient is water loading for weight checks (or difficulty with urine concentration).
  • DEXA- Consider if history of amenorrhea >6 months or prolonged malnutrition.

Differential Diagnosis and Possible Comorbidities

• Weight loss

Gastrointestinal: Inflammatory bowel disease; celiac disease

• Endocrine: Hyperthyroidism; diabetes mellitus; adrenal insufficiency
• Infectious: Chronic infections, such as tuberculosis or HIV; intestinal parasite
• Psychiatric: Depression, anxiety, OCD, psychosis, substance use, gender dysphoria, body dysmorphia, PTSD, ASD (especially ARFID)

Prevalence of Psychiatric Comorbidities
	Anorexia N	Bulimia N	Binge Eating D/O
Major Depression	49.5%	76.3%	65.55%
Anxiety D/O	40.5%	44.6%	59.0%
Suicide Attempts	24.9%	31.4%	22.9%

Crone et al, 2023

• Other: Neoplasm, Superior mesenteric artery syndrome
• Vomiting
• Gastroesophageal disorders: Gastroesophageal reflux disease, eosinophilic esophagitis, pancreatitis, cyclic vomiting, cannabis hyperemesis syndrome
• Neurologic: Migraine, increased intercranial pressure
• Food allergy
• Binge eating or unexplained weight gain
• Endocrine: Hypothyroidism; Hypercortisolism
• Psychiatric: Depression, Anxiety
• Medication adverse effects: (SSRIs, SGAs, etc.)
• Genetic Disorders: Prader-Willi syndrome; Kleine-Levin syndrome
• From Hornberger, et al 2021 Pediatric Guidelines

Potential Complications of Eating Disorders

• Cardiovascular: Bradycardia, hypotension, prolonged QT, arrhythmias, cardiomyopathy, and cardiac failure — approximately one-third of deaths in anorexia nervosa are attributed to cardiovascular complications.
• Endocrine/metabolic: Hypothalamic amenorrhea (77.7% of females with AN), sick euthyroid syndrome, hypoglycemia, hypercortisolemia, delayed puberty, and arrested growth
• Skeletal: Decreased bone mineral density leading to osteoporosis and increased fracture risk with prolonged AN
• GI: Delayed gastric emptying, constipation, superior mesenteric artery syndrome, pancreatitis, elevated transaminases, esophageal erosions or perforation (with purging)
• Electrolyte disturbances: Hypokalemia, hyponatremia, hypophosphatemia, and metabolic alkalosis (vomiting) or acidosis (laxative abuse;) hypoglycemia (also a major cause of mortality)
• Hematologic: Anemia, leukopenia, thrombocytopenia
• Neurologic: Cerebral cortical atrophy (pseudoatrophy, reversible with weight gain), cognitive deficits, peripheral neuropathy
• Renal: Acute kidney injury (from dehydration and purging), renal calculi
• Dental: Erosion of dental enamel from recurrent vomiting

Formulation

• Confirmation of Diagnosis
  Including alterative/differential diagnoses
  Comorbid conditions and complications or other medical issues
• Weight, and degree of malnutrition and metabolic condition
  Establish target goal weight based on anthropomorphic measures, trajectories and pubertal status. (see above)
• Duration and course of illness
• Patient and family insight along with motivation for change
• Previous treatment history and response
• Suicidality or other psychiatric risk factors
• Access to care

Treatment

Core Treatment Goals

Central objectives in treating eating disorders include restoring normal eating behaviors, addressing and correcting distorted beliefs about body shape and weight, and achieving weight restoration when needed. These goals are fundamental to improving overall health and psychological well-being.

Multidisciplinary Team Approach

The treatment of eating disorders requires the involvement of a multidisciplinary team consisting of a primary care clinician, therapist, and dietitian. Establishing a compassionate therapeutic alliance is essential, and the approach should actively engage both the patient and their family to foster support and collaboration throughout the recovery process.

Levels of Care

Treatment settings can vary widely, ranging from outpatient care to residential and inpatient programs. All levels of care involve a multidisciplinary team (primary care clinician, therapist, dietitian), with increasing intensity of supervision and meal support at higher levels.

The selection of the appropriate setting should be guided by symptom severity, vital signs, laboratory findings, age, suicide risk, and treatment history. It is important to choose the least restrictive environment that meets both clinical requirements and patient preferences.

Stepping up and stepping down care

All levels of care incorporate the same multidisciplinary team, but higher levels offer increased supervision and meal support.

Patients should be transitioned to a more intensive setting if outpatient treatment proves ineffective or if medical or psychiatric instability arises.

Conversely, as patients achieve clinical stability, they should be moved to less intensive settings to promote independence and ongoing recovery.

Outpatient Treatment- Preferred

Most patients can be treated in an outpatient setting utilizing collaborative care with a multidisciplinary treatment team that has expertise in treating eating disorders, including the primary care provider, a therapist with expertise in eating disorders, a nutritionist and a psychiatrist or other specialists as indicated. Patients and family should be considered part of the treatment team. It is imperative that the team collaborate and have clear communication.

The primary care provider can assess and monitor health, provide medical information and guidance as well as facilitate referrals and coordinate care with other providers. When a nutritionist is involved, they may help set target weights, recommended rate of and nutritional guidelines in coordination with the PCP and behavioral clinician.

Comorbid psychiatric and medical conditions need to be monitored and addressed, especially given the high incidence of comorbidity and risk.

Partial Hospital Programs (PHP)

-Daily structured outpatient program

4 hours/day, 5 days per week

or Intensive Outpatient Programs (IOP)

– Shorter day, may be non-daily

Indicated when outpatient treatment is insufficient and professional supervision and more frequent and intensive supervision is needed for the patient to eat, gain weight in a healthy and safe manner. Weight is typically 80-90% of Target Treatment Weight

These provide intermediate levels of care with additional structure, treatment modalities and supervision

Often includes structured, monitored meals, group, family and individual therapy

May include medical monitoring and medication management

Residential Treatment

When IOP/PHP is insufficient to enact change or there is need for round the clock supervised treatment

Weight is often 75-80% of Target Treatment Weight

Hospital Based Stabilization and Treatment

When imminent threat to health or safety and need for acute intervention and monitoring are present.

See Criteria for Urgent Assessment/Hospitalization above.

Medical Hospitalization

• Indicated when there is potentially life-threatening medical/metabolic instability
• When less restrictive interventions are unsuccessful
• The cornerstone of inpatient treatment is weight restoration through structured refeeding
• Target weight gain of 0.9–1.8 kg/week in inpatient settings; early and faster weight gain is associated with shorter stays and improved remission rates
• Refeeding Syndrome — Characterized by hypophosphatemia and fluid/electrolyte shifts — is rare and typically mild to moderate, managed with regular electrolyte monitoring and repletion. A more cautious approach may be warranted in severely malnourished patients (<70% median BMI or Target Treatment Weight)
• CCMC Clinical Pathway https://www.connecticutchildrens.org/medical-professionals/clinical-pathways/eating-disorder
• Typically discharged to IOP, PHP or Residential level of care.

Recommended Psychotherapy Treatments

Anorexia Nervosa

For children and adolescents, Family Based Treatment (FBT) is the recommended first-line approach.

Family-based therapy empowers parents to play a vital role in facilitating patients’ weight gain before progressively returning control to the patient. Family-based therapy shows higher remission rates and increased weight gain compared to individual therapy. Short hospitalizations followed by family-based therapy or outpatient programs yield similar outcomes to prolonged hospitalization. Studies of family-based therapy demonstrate higher remission rates and increased weight gain compared with individual therapy. Short hospitalizations for medical stabilization followed by family-based therapy or outpatient programs have similar outcomes as prolonged hospitalization therefore, the safest, least intensive treatment environment is recommended.

For Anorexia Nervosa in adults, no single psychotherapy has demonstrated superiority over others. CBT works by targeting the distorted thoughts and maladaptive behaviors that maintain ED symptoms. Psychodynamic psychotherapy, and specialist supportive clinical management are also options.

Bulimia Nervosa and Binge Eating Disorder

Children and Adolescents: FBT and CBT show positive results.

Adults: CBT is the first-line psychotherapy and is superior to other interventions. For binge-eating disorder, therapist-led CBT and self-help CBT are effective, with in-person CBT more effectively decreasing binge eating and dropout than self-guided CBT. 

CBT focuses on addressing cognitive distortions that contribute to distortions in body image and eating.

Interpersonal Therapy (IT) is also first or second line treatment.

IT focuses on relational and social difficulties linked to problematic eating behaviors.

ARFID

American Academy of Pediatrics (AAP) recommends that management of ARFID focus on the dual goals of refeeding and normalization of eating, consistent with the treatment principles for other eating disorders. Patients with ARFID vary in their underlying psychological motivations for restrictive eating, individualized behavioral treatment strategies are needed.

Cognitive-behavioral therapy for ARFID (CBT-AR) is the most studied manualized treatment. It involves psychoeducation, regularization of eating patterns, exposure to novel/feared foods, and anxiety management.

Virtual Treatment Options- Offer outpatient and intensive outpatient treatment.

• Equip Health www.equip.health
• Within Health https://withinhealth.com/

FINDING TREATMENT RESOURCES:

• ACCESS Mental Health CT  https://www.accessmhct.com/
• NEDA Home – National Eating Disorders Association

Medication Management for Eating Disorders

(not recommended as monotherapy)

Anorexia Nervosa

No FDA-approved medications exist. SSRIs do not promote weight gain or improve psychological symptoms but may be considered for comorbid depression, anxiety, or OCD. (Attia, 2025). However, caution is indicated due to low body weight.

Olanzapine may promote modest weight gain but is not a stand-alone treatment. (Off label)

Bupropion is contraindicated in anorexia and bulimia nervosa due to seizure risk. (Attia, 2025)

Consider Calcium Supplementation: 4-8 yo,1000mg, 9 up 1300mg and

Vitamin D Supplementation: 600iu

Bulimia Nervosa

Fluoxetine 60 mg/day is FDA-approved and reduces binge eating (SMD −0.29) and purging (SMD −0.51) compared with placebo.

The dose of fluoxetine for Bulimia Nervosa (60mg/d) is superior to the dose of 20 mg/d usually used to treat depression. Most effective doses of other SSRIs for bulimia nervosa and binge-eating disorder are not well established.

Binge-eating disorder

Lisdexamfetamine is the only FDA-approved medication.

Second-generation antidepressants and topiramate also reduce binge-eating frequency. A recent RCT found that behavioral weight loss therapy combined with naltrexone-bupropion achieved 57.1% binge-eating remission vs 17.7% with placebo.

ARFID

No medication is approved or specifically indicated for ARFID. Pharmacotherapy should be directed at treating underlying comorbid illness (e.g., anxiety) as necessary.

Cyproheptadine and low dose olanzapine have been used as adjunctive medication off label.

SSRIs have been shown to be helpful especially when there is co morbid anxiety or depression.

Mirtazapine increases appetite and decreases anxiety.

Follow Up and Ongoing Medical Monitoring

Ongoing medical monitoring should continue for the duration of active ED symptoms

In person appointments are necessary to assess safety and progress

Frequency of appointments should be weekly first and decreased as determined by treatment team and based on severity and potential to decline

Appointment should include:

• Assessment of nutritional intake, presence of eating disorder related behaviors (restriction, binging, purging, laxative use)
• Symptoms of malnutrition, dehydration or fluid overload
• Motivation and compliance with treatment plan
• Screening for safety, suicidal risk or self-injury
• Weight check, (consider blinded) and orthostatic vital signs
• Consider EKG or glucose if indicated
• Periodic electrolytes or other labs, especially if binging, purging or at risk for refeeding syndrome
• Collaboration with other treatment team members
• Review recommendations for exercise including modifications and risks
• Consider multi-vitamins, calcium and/or vitamin D supplementation
• Meet confidentially with child as well as young adults while respecting privacy as well as encouraging collaborative family involvement and need to share information. Be mindful of privacy of transitional age adults.

Additional Considerations and Pearls 

Anorexia and Eating Disorders in Males – Symptoms in males may include:

• Body image concerns- focus on muscularity/definition
• Can present with desire to “bulk up” or fear of gaining weight
• Frequent thoughts about body fat percentage or body size
• Frequent thoughts about consuming or avoiding certain foods or entire food groups
• Checking nutritional information before eating any food items
• Driven to lose weight through extreme measures, e.g., excessive exercise, restricting food intake, purging, laxative use
• Persistent negative body image or body dysmorphia
• May obsess about their body size or having too much body fat
• High incidence of use/misuse of nutritional supplements and steroids

Complicated Presentation with Transgender and Other In LGBTQ+ Individuals

• Complex relationship with body image, fat and curves are “weighted” and complex, often result in disordered eating

Complicated presentations including diabetes & chronic disease, ASD and SUD; high risk and need for careful multidisciplinary collaboration

Refeeding Syndrome — Characterized by hypophosphatemia and fluid/electrolyte shifts — is rare and typically mild to moderate, managed with regular electrolyte monitoring and repletion. A more cautious approach may be warranted in severely malnourished patients (<70% median BMI or Target Weight)

Special Consideration with Athletes

“Female Athlete Triad”

• Menstrual Dysfunction, low available energy, decreased bone density.
• Heart rate >50 warrants careful assessment> malnutrition interferes with metabolism and energy demands.
• Exercise restrictions and return to play sports decisions
• Recommendations as to restricting or returning to play sports should be made collaboratively by the treatment team based on factors including: treatment engagement and stage of recovery, achievement and maintenance of target weight, menstrual pattern recovery, lack of low bone density or fractures
• Return should be gradual and monitored
  • 2025 Female Triad Consensus Guidelines https://pubmed.ncbi.nlm.nih.gov/41474492/

“Male Athlete Triad”

• Energy deficiency/low energy availability (with or without disordered eating)
• Suppression of the hypothalamic-pituitary-gonadal axis (functional hypogonadotropic hypogonadism), and
• Impaired bone health, osteoporosis or low bone mineral density with or without bone stress injury (BSI)

Helpful Eating Disorders in Athletes Guideline
https://www.nationaleatingdisorders.org/eating-disorders-and-athletes-2/

EDs occur across all cultural and racial backgrounds

Neurodivergent individuals- at risk for ARFID as well as other eating disorders

ED patients always know more facts about food, but lots of misinformation

• Ask about internet use and eating and body image related websites visited
• PCP in ideal situation to teach about healthy nutrition
• “Food is essential medicine” for recovery from disordered eating

How to talk with patients and families

• Use clear, non-blaming language
• Educate and support. Do not argue or dictate.
• Eating disorders can be severe and are life threatening, even if the child appears healthy, or is an athlete
• Help patients and family to understand that just eating more does not work. Structured multidisciplinary treatment is required.
• Child and Family are an integral part of the treatment team

Multidisciplinary collaboration is an essential part of treatment. PCP plays an essential role in coordinating and collaborating with patients, family, and specialists, may include school and coaches. Communication and methods of information sharing need to be established and clear while respecting privacy.

Resources and Guidelines for Providers

ACCESS MENTAL HEALTH CT www.ACCESSMHCT.COM

• Call us with diagnostic, treatment and resource questions and assistance with referrals/resources. AMHCT Website has resources including webinars, as well as other toolkits. ACCESS Mental Health CT for Moms for help for perinatal issues.

Recommended Guidelines AAP: Identification and Management of Eating Disorders in Children and Adolescents https://doi.org/10.1542/peds.2020-040279

AAFP https://www.aafp.org/pubs/afp/issues/2021/0101/p22.html https://www.aafp.org/pubs/afp/issues/2021/0101/p22.html JAMA Eating Disorders – A Review https://jamanetwork.com/journals/jama/fullarticle/2831140

UBC Comprehensive Toolkit (University of British Columbia) https://ubccpd.ca/sites/default/files/documents/Eating-Disorders-Toolkit-for-PCP-2018.pdf

NEDA Provider Resources:
https://www.nationaleatingdisorders.org/i-have-a-patient-with-an-eating-disorder/

Other Resources

• Bright Futures https://www.brightfutures.org/mentalhealth/pdf/bridges/eat_disorder.pdf
• Eating Disorders in Athletes
  https://www.nationaleatingdisorders.org/eating-disorders-and-athletes-2/
• CCMC (CT Children’s Medical Center) Eating Disorders Clinical Pathway
  https://www.connecticutchildrens.org/medical-professionals/clinical-pathways/eating-disorder

Resources for Families and Patients

• NEDA – https://www.nationaleatingdisorders.org/help-someone/
• AACAP Facts For Families- Teenagers with Eating Disorders
  https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Teenagers-With-Eating-Disorders-002.aspx
• Child Mind Institute
  https://childmind.org/topics/eating-eating-disorders/?gad_source=1&gad_campaignid=23770004383&gbraid=0AAAAADxqHB95sIXDsFUg7a4hNdHcHO9cq&gclid=Cj0KCQjw77bPBhC_ARIsAGAjjV8oWspxNQa6qI8IwpUazO0XTCttVesdof5_-3HNTSH0o0m__BjipL0aAs_FEALw_wcB
• NAMI CT
  https://namict.org
• F.E.A.S.T. (Families Empowered and Supporting Treatment of Eating Disorders)
  https://www.feast-ed.org
• Patients with disordered eating
  https://www.nationaleatingdisorders.org
• Books:
  • ARFID Avoidant Restrictive Food Intake Disorder: A Guide for Parents and Carers (2019), by Rachel Bryant-Waugh
  • When Your Teen Has an Eating Disorder: Practical Strategies to Help Your Teen Recover from Anorexia, Bulimia and Binge Eating (2018), by Lauren Muhlheim PsyD