{"id":1227,"date":"2026-07-07T21:10:56","date_gmt":"2026-07-08T01:10:56","guid":{"rendered":"https:\/\/www.accessmhct.com\/youth\/?page_id=1227"},"modified":"2026-07-08T13:59:22","modified_gmt":"2026-07-08T17:59:22","slug":"eating-disorders","status":"publish","type":"page","link":"https:\/\/www.accessmhct.com\/youth\/resources-2\/provider-toolkit\/eating-disorders\/","title":{"rendered":"Eating Disorders"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\">Eating disorders are potentially life-threatening psychological disorders in which there are pathological eating and related behaviors, as well as disturbances in the experience of food and body, that cause distress and\/or impairment. Early intervention may decrease the risk of long-term pathology and disability.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Prevalence rates of Anorexia and Bulimia are both over 1% in females and 0.3-0.5% in males. Binge Eating Disorder is the most common eating disorder in adults, estimated to affect approximately 1.5 million U.S. adults, followed by Bulimia Nervosa (~500,000) and Anorexia Nervosa (~175,000). For US adolescents aged 13\u201318 years estimated prevalence rates of Anorexia Nervosa is 0.3%, Bulimia Nervosa at 0.9%, and Binge Eating Disorder at 1.6%. The mean age of onset for each disorder was 12.5 years (Attia, 2025).<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">&nbsp;Eating disorders carry significantly elevated mortality risk and are among the highest mortality rates of any psychiatric disorder, with Anorexia Nervosa having over 5% mortality risk ratio or approximately 5\u20136 times that of the general population. Suicide and cardiac deaths are the two predominant causes, accounting for approximately 21% and 19% of deaths, respectively (Semchishen, 2026).<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Primary Care Providers are in an ideal position to prevent, identify, assess and provide ongoing care to individuals and families experiencing eating disorders. Education about nutrition and healthy eating can help with prevention.&nbsp; Primary Care Providers are often the first clinicians to detect disordered eating. Recognizing warning signs and timely screening can lead to early identification. Diagnosis and early intervention can significantly improve patient outcome.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The Primary Care Provider can provide initial assessments to diagnose, medically manage, and facilitate referrals along with participating and helping to coordinate the multidisciplinary treatment team, when indicated.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The unique long-term relationship and established trust of a Primary Care Provider can often be crucial factors in overcoming fear and resistance and help the patient and family engage in treatment.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">This toolkit, provided by ACCESS Mental Health Connecticut, provides a summary of guidelines as well as links to more detailed guidelines and other helpful links for practitioners, patients and families. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">ACCESS Mental Health Connecticut is always just a phone call or click away and is available to help Primary Care Practitioners, their patients and families with diagnostic assistance, advice, resource and referral assistance. <a href=\"http:\/\/www.accessmhct.com\">www.accessmhct.com<\/a> <\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Types of Eating Disorders<\/strong><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Anorexia Nervosa (AN)<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Restricted caloric intake relative to energy requirements, leading to significantly low body weight for age, sex, projected growth, and physical health<\/li>\n\n\n\n<li><span style=\"color: initial;\">Intense fear of gaining weight or behaviors that consistently interfere with weight gain, despite being at a significantly low weight<\/span><\/li>\n\n\n\n<li>Altered perception of one\u2019s body weight or shape, excessive influence of body weight or shape on self-value, or persistent lack of acknowledgment of the seriousness of one\u2019s low body weight<br><br><strong style=\"color: initial;\">Subtypes:<\/strong>\n<ul class=\"wp-block-list\">\n<li><em>Restricting Type:<\/em> Weight loss is achieved primarily through dieting, fasting, and\/or excessive exercise. In the previous 3 months there have been no repeated episodes of binge eating or purging<\/li>\n\n\n\n<li><em>Binge-Eating\/Purging Type<\/em>: In the previous 3 months there have been repeated episodes of binge eating or purging, i.e., self-induced vomiting or misuse of laxatives, diuretics, or enemas<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Bulimia Nervosa (BN)<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Repeated episodes of binge eating. Binge eating is characterized by both of the following: within a distinct period of time (e.g., 2 hours), eating an amount of food that is clearly larger than what most individuals would eat during a similar period of time under similar circumstances and a sense that one cannot limit or control their overeating during the episode<\/li>\n\n\n\n<li>Repeated use of inappropriate compensatory behaviors for the prevention of weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting; or excessive exercise<\/li>\n\n\n\n<li>On average, binge eating and compensatory behaviors both occur at least once a week for 3 months<\/li>\n\n\n\n<li>Self-value is overly influenced by body shape and weight<\/li>\n\n\n\n<li>The binge eating and compensatory behaviors do not occur exclusively during episodes of AN<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Binge Eating Disorder (BED)<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following: within a distinct period of time (e.g., 2 hours), eating an amount of food that is clearly larger than what most individuals would eat during a similar period of time under similar circumstances and sense that one cannot limit or control their overeating during the episode<\/li>\n\n\n\n<li>The binge eating episodes include 3 or more of the following: eating much more quickly than normal, eating until uncomfortably full, eating large amounts of food when not feeling hungry, eating alone because of embarrassment at how much one is eating, and feeling guilty, disgusted, or depressed afterward<\/li>\n\n\n\n<li>Marked anguish is experienced regarding binge eating<\/li>\n\n\n\n<li>On average, binge eating occurs at least once a week for 3 months<\/li>\n\n\n\n<li>The binge eating is not associated with the use of inappropriate compensatory behavior as in BN and does not occur only in the context of BN or AN<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Avoidant and Restrictive Food Intake Disorder (ARFID)<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>A disrupted eating pattern (e.g., seeming lack of interest in eating or food; avoidance based on the sensory qualities of food; concern about unpleasant consequences of eating) as evidenced by persistent failure to meet appropriate nutritional and\/or energy needs associated with 1 (or more) of the following: significant weight loss or, in children, failure to achieve expected growth and\/or weight gain, marked nutritional deficiency, reliance on enteral feeding or oral nutritional supplements, significant interference with psychosocial functioning<\/li>\n\n\n\n<li>The disturbance cannot be better explained by lack of available food or by an associated culturally sanctioned practice<\/li>\n\n\n\n<li>The eating disturbance cannot be attributed to a coexisting medical condition nor better explained by another mental disorder. If the eating disturbance occurs in the context of another condition or disorder, the severity of the eating disturbance exceeds that routinely associated with the condition or disorder<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Other Specified Feeding or Eating Disorder (OSFED)<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Other specified feeding or eating disorders that do not meet criteria for other eating disorders noted above including:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Atypical Anorexia:<br>All the criteria for AN are met yet the individual\u2019s weight is within or above the normal range despite significant weight loss<\/li>\n\n\n\n<li><span style=\"color: initial;\">Bulimia Nervosa of Low Frequency and\/or Limited Duration:<\/span><br><span style=\"color: initial;\">All of the criteria for BN are met, but on average, the binge eating and compensatory behaviors occur less than once a week and\/or for &lt;3 months<\/span><\/li>\n\n\n\n<li><span style=\"color: initial;\">BED of Low Frequency and\/or Limited Duration:<\/span><br><span style=\"color: initial;\">All of the criteria for BED are met, but on average, the binge eating occurs less than once a week and\/or for &lt;3 months<\/span><\/li>\n\n\n\n<li><span style=\"color: initial;\">Purging disorder:<\/span><br><span style=\"color: initial;\">Recurrent purging behavior (e.g., self-induced vomiting; misuse of laxatives, diuretics, or other medications) in the absence of binge eating with the intent to influence weight or body shape<\/span><\/li>\n\n\n\n<li>Orthorexia:<br>Irrational preoccupation or obsession with healthy eating associated with restrictive behaviors that become counterproductive and may lead to disordered eating, malnourishment, poor health and quality of life<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<div class=\"wp-block-esab-accordion accordion-fa8dac5a\" data-mode=\"global\"><div class=\"esab__container\">\n<div class=\"wp-block-esab-accordion-child\"><div class=\"esab__head\" role=\"button\" aria-expanded=\"false\"><div class=\"esab__heading_txt\"><p class=\"esab__heading_tag\">Guidelines for Diagnosis and Screening<\/p><\/div><div class=\"esab__icon\"><div class=\"esab__collapse\"> <svg version=\"1.2\" viewBox=\"0 0 24 24\" width=\"24\" height=\"24\"><path fill-rule=\"evenodd\" d=\"m3.5 20.5c-4.7-4.7-4.7-12.3 0-17 4.7-4.7 12.3-4.7 17 0 4.6 4.7 4.6 12.3 0 17-4.7 4.6-12.3 4.6-17 0zm0.9-0.9c4.2 4.2 11 4.2 15.2 0 4.2-4.2 4.2-11 0-15.2-4.2-4.3-11-4.3-15.2 0-4.3 4.2-4.3 11 0 15.2z\"><\/path><path d=\"m11.4 15.9v-3.3h-3.3c-0.3 0-0.6-0.3-0.6-0.6 0-0.4 0.3-0.6 0.6-0.6h3.3v-3.3c0-0.3 0.3-0.6 0.6-0.6 0.3 0 0.6 0.3 0.6 0.6v3.3h3.3c0.3 0 0.6 0.2 0.6 0.6q0 0.2-0.2 0.4-0.2 0.2-0.4 0.2h-3.3v3.3q0 0.2-0.2 0.4-0.2 0.2-0.4 0.2c-0.4 0-0.6-0.3-0.6-0.6z\"><\/path><\/svg> <\/div><div class=\"esab__expand\"> <svg version=\"1.2\" viewBox=\"0 0 24 24\" width=\"24\" height=\"24\"><path fill-rule=\"evenodd\" d=\"m12 24c-6.6 0-12-5.4-12-12 0-6.6 5.4-12 12-12 6.6 0 12 5.4 12 12 0 6.6-5.4 12-12 12zm10.6-12c0-5.9-4.7-10.6-10.6-10.6-5.9 0-10.6 4.7-10.6 10.6 0 5.9 4.7 10.6 10.6 10.6 5.9 0 10.6-4.7 10.6-10.6z\"><\/path><path d=\"m5.6 11.3h12.8v1.4h-12.8z\"><\/path><\/svg> <\/div><\/div><\/div><div class=\"esab__body\">\n<h3 class=\"wp-block-heading\"><strong>Early Identification\/Initial Screening<\/strong><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Early Identification is key. PCPs are in a unique position to detect disordered eating early and interrupt their progression (Hornberger et al, 2021).<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><span style=\"text-decoration: underline;\">All disordered eating is not an eating disorder.<\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">\u201cDisordered eating\u201d 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.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><span style=\"text-decoration: underline;\">Screen during routine visits or other symptom related appointments<\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Red Flags<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Physical\n<ul class=\"wp-block-list\">\n<li>Falling off Growth Curve or fluctuations in weight<\/li>\n\n\n\n<li><span style=\"color: initial;\">Cardiovascular: Dizziness or syncope, orthostatic changes, bradycardia<\/span><\/li>\n\n\n\n<li><span style=\"color: initial;\">Cold intolerance<\/span><\/li>\n\n\n\n<li><span style=\"color: initial;\">Amenorrhea<\/span><\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><span style=\"color: initial;\">Behavioral<\/span>\n<ul class=\"wp-block-list\">\n<li><span style=\"color: initial;\">Rigidity around food, meal avoidance<\/span><\/li>\n\n\n\n<li><span style=\"color: initial;\">Cutting food into tiny pieces and decreased intake<\/span><\/li>\n\n\n\n<li><span style=\"color: initial;\">Excessive exercise<\/span><\/li>\n\n\n\n<li><span style=\"color: initial;\">Social withdrawal<\/span><\/li>\n\n\n\n<li><span style=\"color: initial;\">Change in attire or appearance<\/span><\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><span style=\"color: initial;\">Cognitive<\/span>\n<ul class=\"wp-block-list\">\n<li><span style=\"color: initial;\">Intense fear of weight gain<\/span><\/li>\n\n\n\n<li><span style=\"color: initial;\">Distorted body image<\/span><\/li>\n\n\n\n<li><span style=\"color: initial;\">Perfectionism<\/span><\/li>\n\n\n\n<li><span style=\"color: initial;\">Rigid, black and white thinking, especially around food or health<\/span><\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Family<ul><li>Increasing mealtime conflict<\/li><\/ul><ul><li>Hidden food<\/li><\/ul><ul><li>Parental concerns about sudden behavioral changes<\/li><\/ul>\n<ul class=\"wp-block-list\">\n<li>Food or body focused screen use<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Screening tools (Use when disordered eating is suspected)<\/strong><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">(Helpful but not diagnostic, significant false negative or positive and do not include screening questions for ARFID)<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>ESP-PC (Eating Disorder Screen for Primary Care)<\/strong><br><a><\/a><a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC1494802\/\">https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC1494802\/<\/a><\/p>\n\n\n\n<ol class=\"wp-block-list\">\n<li>Are you satisfied with your eating patterns?<br><em>(A \u201cno\u201d to this question is classified as an abnormal response).<\/em><\/li>\n\n\n\n<li>Do you ever eat in secret?<br><em>(A \u201cyes\u201d to this and all other questions are classified as an abnormal response).<\/em><\/li>\n\n\n\n<li>Does your weight affect the way you feel about yourself?<\/li>\n\n\n\n<li>Have any members of your family suffered with an eating disorder?<\/li>\n\n\n\n<li>Do you currently suffer with or have you ever suffered in the past with an eating disorder?<\/li>\n<\/ol>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>SCOFF:<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/eatrightmich.org\/wp-content\/media\/Modified-SCOFF-2021.pdf\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>SCOFF Questionnaire&nbsp;<\/strong><\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>SDE (Screen for Disordered Eating) 5 item screen:<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.nyeatingdisorders.org\/_assets\/pdf\/screen_for_disordered_eating.pdf\">https:\/\/www.nyeatingdisorders.org\/_assets\/pdf\/screen_for_disordered_eating.pdf<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>BRIGHT FUTURES &#8211; Eating Disorders Screening Questions<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.brightfutures.org\/mentalhealth\/pdf\/bridges\/eat_disorder.pdfa\">https:\/\/www.brightfutures.org\/mentalhealth\/pdf\/bridges\/eat_disorder.pdfa<\/a><\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-esab-accordion-child\"><div class=\"esab__head\" role=\"button\" aria-expanded=\"false\"><div class=\"esab__heading_txt\"><p class=\"esab__heading_tag\">Guidelines for Assessment<\/p><\/div><div class=\"esab__icon\"><div class=\"esab__collapse\"> <svg version=\"1.2\" viewBox=\"0 0 24 24\" width=\"24\" height=\"24\"><path fill-rule=\"evenodd\" d=\"m3.5 20.5c-4.7-4.7-4.7-12.3 0-17 4.7-4.7 12.3-4.7 17 0 4.6 4.7 4.6 12.3 0 17-4.7 4.6-12.3 4.6-17 0zm0.9-0.9c4.2 4.2 11 4.2 15.2 0 4.2-4.2 4.2-11 0-15.2-4.2-4.3-11-4.3-15.2 0-4.3 4.2-4.3 11 0 15.2z\"><\/path><path d=\"m11.4 15.9v-3.3h-3.3c-0.3 0-0.6-0.3-0.6-0.6 0-0.4 0.3-0.6 0.6-0.6h3.3v-3.3c0-0.3 0.3-0.6 0.6-0.6 0.3 0 0.6 0.3 0.6 0.6v3.3h3.3c0.3 0 0.6 0.2 0.6 0.6q0 0.2-0.2 0.4-0.2 0.2-0.4 0.2h-3.3v3.3q0 0.2-0.2 0.4-0.2 0.2-0.4 0.2c-0.4 0-0.6-0.3-0.6-0.6z\"><\/path><\/svg> <\/div><div class=\"esab__expand\"> <svg version=\"1.2\" viewBox=\"0 0 24 24\" width=\"24\" height=\"24\"><path fill-rule=\"evenodd\" d=\"m12 24c-6.6 0-12-5.4-12-12 0-6.6 5.4-12 12-12 6.6 0 12 5.4 12 12 0 6.6-5.4 12-12 12zm10.6-12c0-5.9-4.7-10.6-10.6-10.6-5.9 0-10.6 4.7-10.6 10.6 0 5.9 4.7 10.6 10.6 10.6 5.9 0 10.6-4.7 10.6-10.6z\"><\/path><path d=\"m5.6 11.3h12.8v1.4h-12.8z\"><\/path><\/svg> <\/div><\/div><\/div><div class=\"esab__body\">\n<h3 class=\"wp-block-heading\">Goals of Assessment and Treatment<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">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).<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Establish Diagnosis\n<ul class=\"wp-block-list\">\n<li>Identify possible alterative diagnoses and comorbid conditions<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Assess nutritional and metabolic conditions and establish a Target Treatment Weight goal, utilizing anthropomorphic measures and trends over time<\/li>\n\n\n\n<li><span style=\"color: initial;\">Assess motivation for change and family engagement<\/span><\/li>\n\n\n\n<li>Recommend and refer for appropriate treatment and level of care<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading has-vivid-red-color has-text-color has-link-color wp-elements-a1ca7dbacab77ac4afb9b8ae1e606392\"><strong>IS THERE A NEED FOR URGENT ASSESMENT\/HOSPTALIZATION?<\/strong><\/h3>\n\n\n\n<p class=\"has-vivid-red-color has-text-color has-link-color wp-elements-b2f9bb06dbdb4d7b0363ca832c7eb1fe wp-block-paragraph\"><strong>*** 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.<\/strong><\/p>\n\n\n\n<p class=\"has-vivid-red-color has-text-color has-link-color wp-elements-33a3d5e41dd7186984112debe6995adf wp-block-paragraph\"><strong>Suggested Criteria:<\/strong><\/p>\n\n\n\n<p class=\"has-vivid-red-color has-text-color has-link-color wp-elements-afc165c103dacf0704db3e0d95ef1135 wp-block-paragraph\"><strong><u>One or more of the following justify referral for urgent assessment and hospitalization<\/u><\/strong>:<\/p>\n\n\n\n<ol class=\"wp-block-list\">\n<li>75% median body mass index for age and sex (Adults BMI&lt;15)<\/li>\n\n\n\n<li>Dehydration<\/li>\n\n\n\n<li>Electrolyte disturbance<br>(K&lt;3.0mEq\/L, Na&lt;130mEq\/L, Phos&lt;2.0mg\/dL, Mg&lt;1.5mg\/dL, Glucose&lt;60 mg\/dl)<\/li>\n\n\n\n<li>EKG abnormalities (e.g., prolonged QTc or severe bradycardia or other arrythmia)<\/li>\n\n\n\n<li>Physiological instability\n<ul class=\"wp-block-list\">\n<li style=\"font-style:normal;font-weight:400\">Severe Bradycardia<br>(&lt;50 beats\/minute (at daytime. &lt;45 beats\/minute at night)<\/li>\n\n\n\n<li style=\"font-style:normal;font-weight:400\">Hypotension (&lt;90\/45 mm Hg)<\/li>\n\n\n\n<li style=\"font-style:normal;font-weight:400\">Hypothermia (body temperature &lt;96 F, 35.6 C)<\/li>\n\n\n\n<li style=\"font-style:normal;font-weight:400\">Orthostatic increase in pulse (&gt;20 beats per minute) or decrease in blood pressure. <br>(&gt;20 mm Hg systolic or &gt;10 mm Hg diastolic)<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Arrested growth and development<\/li>\n\n\n\n<li>Failure of outpatient treatment<\/li>\n\n\n\n<li>Acute food refusal<\/li>\n\n\n\n<li>Uncontrollable bingeing and purging<\/li>\n\n\n\n<li>Acute medical complications of malnutrition (e.g., syncope, seizures, cardiac failure, pancreatitis, etc.)<\/li>\n\n\n\n<li>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)<br>    *From: Golden et al, 2015<\/li>\n<\/ol>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Additional Considerations:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>&gt; 10% loss of Body Massin 6 months or &gt;20% Loss over 12 months<\/li>\n\n\n\n<li>Hypothermia (Body temp&lt;36 degrees C)<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>History<\/strong><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Review psychosocial history including:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Weight history (loss, gain, fluctuations)<\/li>\n\n\n\n<li>Body image, general, dysmorphia?<\/li>\n\n\n\n<li>History of dieting, use of diuretics, laxatives, supplements, steroids<\/li>\n\n\n\n<li>Eating patterns (dieting, weight control behaviors, binging, purging, fasting, skipping meals)<\/li>\n\n\n\n<li>Cognitive symptoms: fear of weight gain, fat, distorted body image, perfectionism<\/li>\n\n\n\n<li>Exercise: excessive exercise, purpose, change<\/li>\n\n\n\n<li>Menstrual pattern: menarche, MP, amenorrhea?<\/li>\n\n\n\n<li>Other review of symptoms\n<ul class=\"wp-block-list\">\n<li>Dizziness, syncope, weakness or fatigue<\/li>\n\n\n\n<li>Pallor, cold intolerance or bruising<\/li>\n\n\n\n<li>Hair (loss, lanugo) or skin changes<\/li>\n\n\n\n<li>GI: constipation, diarrhea, fullness or bloating<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Psychosocial history- including but not limited to:\n<ul class=\"wp-block-list\">\n<li>Mood issues or changes (anxiety, compulsions, depression)<\/li>\n\n\n\n<li>Suicidality, self-injury thoughts or behavior<\/li>\n\n\n\n<li>History of trauma or abuse<\/li>\n\n\n\n<li>Family- History of mental health issues, stressors, conflict, meal patterns<\/li>\n\n\n\n<li>Academic, social and extracurricular activities<\/li>\n\n\n\n<li>Internet and app use, esp. related to body and eating issues.<\/li>\n\n\n\n<li>Menstrual and Sexual history<br>(e.g., menarche, last menstrual period, regularity)\n<ul class=\"wp-block-list\">\n<li>Oral contraceptive use-oral contraceptive use may be masking the impact of eating disorder on menstrual status)<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Substance use (including nicotine, vapes, energy drinks, steroids)<\/li>\n\n\n\n<li>Previous history of mental health diagnosis or treatment<\/li>\n\n\n\n<li>Medication history\n<ul class=\"wp-block-list\">\n<li>Current medications and supplements<\/li>\n\n\n\n<li>Past medications and supplements<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Physical Assessment<\/strong><\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>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<\/li>\n\n\n\n<li>Sitting and orthostatic heart rate and blood pressure&nbsp;<\/li>\n\n\n\n<li>Body temperature<\/li>\n\n\n\n<li>Hydration status (e.g., poor skin turgor, slow capillary return)<\/li>\n\n\n\n<li>Assessment of skin, hair and nails (e.g., brittle nails, carotenaemia [orange discoloration], dry skin, lanugo hair, callused knuckles)&nbsp;<\/li>\n\n\n\n<li>Oral examination (e.g., dental erosions, gingivitis, pharyngeal redness and parotid enlargement)<\/li>\n\n\n\n<li>Assessment of breathing and breath (e.g., ketosis)&nbsp;<\/li>\n\n\n\n<li>Examination of peripheral circulation and edema<\/li>\n\n\n\n<li>Gastrointestinal function (e.g., bloating, pain, constipation, diarrhea)<\/li>\n\n\n\n<li>Mental Status including safety and suicide risk assessment<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Estimating Severity of Malnutrition\/Determining Target Goal Weight<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">(from Golden et al, 2015)<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>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.<\/li>\n\n\n\n<li><span style=\"color: initial;\">For adolescents, individual\u2019s treatment goal weight range should consider the premorbid trajectory for height, weight, and BMI, age at pubertal onset, and current pubertal stage.<\/span><\/li>\n\n\n\n<li>A two-step process is helpful as follows:\n<ol class=\"wp-block-list\">\n<li>Determination of the degree of malnutrition compared with the reference population using percent median BMI and z scores as described previously, and then\u2026<\/li>\n\n\n\n<li>Determining a healthy weight range for that individual, based on previous the individual\u2019s 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.<\/li>\n<\/ol>\n<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">A proposed classification of the degree of malnutrition for adolescents with eating disorders:<\/p>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"has-fixed-layout\"><tbody><tr><td>&nbsp;<\/td><td>Mild<\/td><td>Moderate<\/td><td>Severe<\/td><\/tr><tr><td>% Median BMI<\/td><td>80-90%<\/td><td>70-79%<\/td><td>&lt;70%<\/td><\/tr><tr><td>MBI z score<\/td><td>-1 to-1.9<\/td><td>-2 to -2.9<\/td><td>&#8211; 3 or more<\/td><\/tr><tr><td>Weight Loss<\/td><td>&gt;10% Body mass loss<\/td><td>&gt;15% Body Mass loss<\/td><td>20% body mass loss in 1 year &nbsp;Or &gt;10% loss in 6 months<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">Golden et al, 2015<br>CDC Growth Charts: <a href=\"https:\/\/www.cdc.gov\/growthcharts\/\">https:\/\/www.cdc.gov\/growthcharts\/<\/a><br>CDC BMI Charts<a>: <\/a><a href=\"https:\/\/www.cdc.gov\/growthcharts\/Extended-BMI-Charts.html\">https:\/\/www.cdc.gov\/growthcharts\/Extended-BMI-Charts.html<\/a><\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Laboratory and Other Assessments<\/strong> <\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">(for complications and differential diagnosis)<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Primary Care Providers are crucial in evaluating medical stability and determining the urgency of treatment for patients with eating disorders.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Assess for medical instability<\/strong>: Assess vital signs, orthostatic measurements, EKG, electrolytes, and hydration status to evaluate medical risk. (See Hospitalization Criteria above)<\/li>\n\n\n\n<li><strong>Core Medical Stability Labs<\/strong><br>Laboratory assessments help identify dehydration, electrolyte shifts, organ stress, and complications from purging or restriction.\n<ul class=\"wp-block-list\">\n<li>CBC with Diff: Neutropenia, thrombocytopenia, and bone marrow suppression.<\/li>\n\n\n\n<li>CMP: Evaluates electrolytes, renal function, liver enzymes, and glucose.<\/li>\n\n\n\n<li>Magnesium and phosphorus: Critical for identifying risk of refeeding syndrome and purging-related losses.<\/li>\n\n\n\n<li>Consider the possibility of reactive hypoglycemia due to depletion of glycogen storage. Asymptomatic hypoglycemia is associated with sudden death in anorexia nervosa.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong style=\"color: initial;\">Purging\u2011Related Labs<\/strong>\n<ul class=\"wp-block-list\">\n<li>These tests detect salivary gland stress, pancreatic irritation, and metabolic alkalosis.<\/li>\n\n\n\n<li>Amylase and Lipase: Elevated amylase can indicate vomiting; lipase is useful to rule out pancreatitis.<\/li>\n\n\n\n<li>Serum Bicarbonate (part of CMP): Metabolic alkalosis may suggest vomiting; metabolic acidosis may indicate laxative abuse.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Nutritional Deficiency Labs<\/strong>\n<ul class=\"wp-block-list\">\n<li>These tests reveal common deficiencies in restrictive eating disorders and inform ongoing medical monitoring.<\/li>\n\n\n\n<li>Iron studies (Iron, TIBC, Ferritin): Screens for iron deficiency or anemia of chronic disease.<\/li>\n\n\n\n<li>Vitamin B12 level: Identifies deficiency that may contribute to fatigue, neuropathy, or cognitive symptoms.<\/li>\n\n\n\n<li>Zinc level: Low zinc is common in restrictive EDs and can worsen appetite and taste perception.<\/li>\n\n\n\n<li>Vitamin D level: Important for bone health, especially in amenorrhea or low-weight states.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Medical Mimics and Comorbid Conditions<\/strong>\n<ul class=\"wp-block-list\">\n<li>These tests help rule out conditions that can present weight loss, gastrointestinal symptoms, or changes in appetite.<\/li>\n\n\n\n<li>Celiac panel (tTG\u2011IgA and total IgA): Screens for malabsorption and autoimmune GI disease.<\/li>\n\n\n\n<li>TSH and free T4: Screens for thyroid disease that can mimic or complicate eating disorder symptoms.<\/li>\n\n\n\n<li>Estradiol, FSH, LH, Testosterone based on history.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Other tests\n<ul class=\"wp-block-list\">\n<li>Urine Analysis with specific gravity: High suggests dehydration, low suggests patient is water loading for weight checks (or difficulty with urine concentration).<\/li>\n\n\n\n<li>DEXA- Consider if history of amenorrhea &gt;6 months or prolonged malnutrition.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Differential Diagnosis and Possible Comorbidities<\/strong><\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Weight loss<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Gastrointestinal: Inflammatory bowel disease; celiac disease<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Endocrine: Hyperthyroidism; diabetes mellitus; adrenal insufficiency<\/li>\n\n\n\n<li>Infectious: Chronic infections, such as tuberculosis or HIV; intestinal parasite<\/li>\n\n\n\n<li>Psychiatric: Depression, anxiety, OCD, psychosis, substance use, gender dysphoria, body dysmorphia, PTSD, ASD (especially ARFID)<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"has-fixed-layout\"><tbody><tr><td colspan=\"4\"><strong>Prevalence of Psychiatric Comorbidities<\/strong><\/td><\/tr><tr><td>&nbsp;<\/td><td><strong>Anorexia N<\/strong><\/td><td><strong>Bulimia N<\/strong><\/td><td><strong>Binge Eating D\/O<\/strong><\/td><\/tr><tr><td><strong>Major Depression<\/strong><\/td><td>49.5%<\/td><td>76.3%<\/td><td>65.55%<\/td><\/tr><tr><td><strong>Anxiety D\/O<\/strong><\/td><td>40.5%<\/td><td>44.6%<\/td><td>59.0%<\/td><\/tr><tr><td><strong>Suicide Attempts<\/strong><\/td><td>24.9%<\/td><td>31.4%<\/td><td>22.9%<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">Crone et al, 2023<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Other: Neoplasm, Superior mesenteric artery syndrome<\/li>\n\n\n\n<li>Vomiting<\/li>\n\n\n\n<li>Gastroesophageal disorders: Gastroesophageal reflux disease, eosinophilic esophagitis, pancreatitis, cyclic vomiting, cannabis hyperemesis syndrome<\/li>\n\n\n\n<li>Neurologic: Migraine, increased intercranial pressure<\/li>\n\n\n\n<li>Food allergy<\/li>\n\n\n\n<li>Binge eating or unexplained weight gain<\/li>\n\n\n\n<li>Endocrine: Hypothyroidism; Hypercortisolism<\/li>\n\n\n\n<li>Psychiatric: Depression, Anxiety<\/li>\n\n\n\n<li>Medication adverse effects: (SSRIs, SGAs, etc.)<\/li>\n\n\n\n<li>Genetic Disorders: Prader-Willi syndrome; Kleine-Levin syndrome<\/li>\n\n\n\n<li>From Hornberger, et al 2021 Pediatric Guidelines<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Potential Complications of Eating Disorders<\/strong><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Cardiovascular: Bradycardia, hypotension, prolonged QT, arrhythmias, cardiomyopathy, and cardiac failure \u2014 approximately one-third of deaths in anorexia nervosa are attributed to cardiovascular complications.<\/li>\n\n\n\n<li><span style=\"color: initial;\">Endocrine\/metabolic: Hypothalamic amenorrhea (77.7% of females with AN), sick euthyroid syndrome, hypoglycemia, hypercortisolemia, delayed puberty, and arrested growth<\/span><\/li>\n\n\n\n<li><span style=\"color: initial;\">Skeletal: Decreased bone mineral density leading to osteoporosis and increased fracture risk with prolonged AN<\/span><\/li>\n\n\n\n<li><span style=\"color: initial;\">GI: Delayed gastric emptying, constipation, superior mesenteric artery syndrome, pancreatitis, elevated transaminases, esophageal erosions or perforation (with purging)<\/span><\/li>\n\n\n\n<li><span style=\"color: initial;\">Electrolyte disturbances: Hypokalemia, hyponatremia, hypophosphatemia, and metabolic alkalosis (vomiting) or acidosis (laxative abuse;) hypoglycemia (also a major cause of mortality)<\/span><\/li>\n\n\n\n<li><span style=\"color: initial;\">Hematologic: Anemia, leukopenia, thrombocytopenia<\/span><\/li>\n\n\n\n<li><span style=\"color: initial;\">Neurologic: Cerebral cortical atrophy (pseudoatrophy, reversible with weight gain), cognitive deficits, peripheral neuropathy<\/span><\/li>\n\n\n\n<li><span style=\"color: initial;\">Renal: Acute kidney injury (from dehydration and purging), renal calculi<\/span><\/li>\n\n\n\n<li>Dental: Erosion of dental enamel from recurrent vomiting<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Formulation<\/strong><\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Confirmation of Diagnosis<br>Including alterative\/differential diagnoses<br>Comorbid conditions and complications or other medical issues<\/li>\n\n\n\n<li>Weight, and degree of malnutrition and metabolic condition<br>Establish target goal weight based on anthropomorphic measures, trajectories and pubertal status. (see above)<\/li>\n\n\n\n<li>Duration and course of illness<\/li>\n\n\n\n<li>Patient and family insight along with motivation for change<\/li>\n\n\n\n<li>Previous treatment history and response<\/li>\n\n\n\n<li>Suicidality or other psychiatric risk factors<\/li>\n\n\n\n<li>Access to care<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Treatment<\/strong><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Core Treatment Goals<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">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.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Multidisciplinary Team Approach<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">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.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Levels of Care<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">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.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">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.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Stepping up and stepping down care<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">All levels of care incorporate the same multidisciplinary team, but higher levels offer increased supervision and meal support.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Patients should be transitioned to a more intensive setting if outpatient treatment proves ineffective or if medical or psychiatric instability arises.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Conversely, as patients achieve clinical stability, they should be moved to less intensive settings to promote independence and ongoing recovery.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Outpatient Treatment- Preferred<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">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.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">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.\u00a0When a nutritionist is involved, they may help set target weights, recommended rate of and nutritional guidelines in coordination with the PCP and behavioral clinician.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Comorbid psychiatric and medical conditions need to be monitored and addressed, especially given the high incidence of comorbidity and risk.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Partial Hospital Programs (PHP)<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">-Daily structured outpatient program<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">4 hours\/day, 5 days per week<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>or Intensive Outpatient Programs (IOP)<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>&#8211;<\/strong> Shorter day, may be non-daily<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">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<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">These provide intermediate levels of care with additional structure, treatment modalities and supervision<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Often includes structured, monitored meals, group, family and individual therapy<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">May include medical monitoring and medication management<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Residential Treatment<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">When IOP\/PHP is insufficient to enact change or there is need for round the clock supervised treatment<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Weight is often 75-80% of Target Treatment Weight<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Hospital Based<\/strong> <strong>Stabilization and Treatment<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">When imminent threat to health or safety and need for acute intervention and monitoring are present.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>See Criteria for Urgent Assessment\/Hospitalization above.<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Medical Hospitalization<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Indicated when there is potentially life-threatening medical\/metabolic instability<\/li>\n\n\n\n<li>When less restrictive interventions are unsuccessful<\/li>\n\n\n\n<li>The cornerstone of inpatient treatment is weight restoration through structured refeeding<\/li>\n\n\n\n<li>Target weight gain of 0.9\u20131.8 kg\/week in inpatient settings; early and faster weight gain is associated with shorter stays and improved remission rates<\/li>\n\n\n\n<li>Refeeding Syndrome \u2014 Characterized by hypophosphatemia and fluid\/electrolyte shifts \u2014 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 (&lt;70% median BMI or Target Treatment Weight)<\/li>\n\n\n\n<li>CCMC Clinical Pathway <a><\/a><a href=\"https:\/\/www.connecticutchildrens.org\/medical-professionals\/clinical-pathways\/eating-disorder\">https:\/\/www.connecticutchildrens.org\/medical-professionals\/clinical-pathways\/eating-disorder<\/a><\/li>\n\n\n\n<li>Typically discharged to IOP, PHP or Residential level of care.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Recommended Psychotherapy Treatments<\/strong><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Anorexia Nervosa<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">For children and adolescents, Family Based Treatment (FBT) is the recommended first-line approach.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Family-based therapy empowers parents to play a vital role in facilitating patients&#8217; 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.\u00a0Studies of family-based therapy demonstrate higher remission rates and increased weight gain compared with individual therapy.\u00a0Short 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.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">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.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Bulimia Nervosa and Binge Eating Disorder<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Children and Adolescents: FBT and CBT show positive results.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">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.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">CBT focuses on addressing cognitive distortions that contribute to distortions in body image and eating.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Interpersonal Therapy (IT) is also first or second line treatment.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">IT focuses on relational and social difficulties linked to problematic eating behaviors.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>ARFID<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">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.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">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.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Virtual Treatment Options- Offer outpatient and intensive outpatient treatment.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Equip Health <a href=\"http:\/\/www.equip.health\">www.equip.health<\/a><\/li>\n\n\n\n<li>Within Health <a href=\"https:\/\/withinhealth.com\/\">https:\/\/withinhealth.com\/<\/a><\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">FINDING TREATMENT RESOURCES:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>ACCESS Mental Health CT&nbsp; <a href=\"https:\/\/www.accessmhct.com\/\">https:\/\/www.accessmhct.com\/<\/a><\/li>\n\n\n\n<li>NEDA <a href=\"https:\/\/www.nationaleatingdisorders.org\/\">Home &#8211; National Eating Disorders Association<\/a><\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Medication Management for Eating Disorders<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">(not recommended as monotherapy)<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Anorexia Nervosa<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">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.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Olanzapine may promote modest weight gain but is not a stand-alone treatment. (Off label)<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Bupropion is contraindicated in anorexia and bulimia nervosa due to seizure risk. (Attia, 2025)<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Consider Calcium Supplementation: 4-8 yo,1000mg, 9 up 1300mg and<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Vitamin D Supplementation: 600iu<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Bulimia Nervosa<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Fluoxetine 60 mg\/day is FDA-approved and reduces binge eating (SMD \u22120.29) and purging (SMD \u22120.51) compared with placebo.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">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.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Binge-eating disorder<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Lisdexamfetamine is the only FDA-approved medication.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">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.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>ARFID<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">No medication is approved or specifically indicated for ARFID. Pharmacotherapy should be directed at treating underlying comorbid illness (e.g., anxiety) as necessary.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Cyproheptadine and low dose olanzapine have been used as adjunctive medication off label.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">SSRIs have been shown to be helpful especially when there is co morbid anxiety or depression.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Mirtazapine increases appetite and decreases anxiety.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Follow Up and Ongoing Medical Monitoring<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Ongoing medical monitoring should continue for the duration of active ED symptoms<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">In person appointments are necessary to assess safety and progress<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Frequency of appointments should be weekly first and decreased as determined by treatment team and based on severity and potential to decline<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Appointment should include:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Assessment of nutritional intake, presence of eating disorder related behaviors (restriction, binging, purging, laxative use)<\/li>\n\n\n\n<li>Symptoms of malnutrition, dehydration or fluid overload<\/li>\n\n\n\n<li>Motivation and compliance with treatment plan<\/li>\n\n\n\n<li>Screening for safety, suicidal risk or self-injury<\/li>\n\n\n\n<li>Weight check, (consider blinded) and orthostatic vital signs<\/li>\n\n\n\n<li>Consider EKG or glucose if indicated<\/li>\n\n\n\n<li>Periodic electrolytes or other labs, especially if binging, purging or at risk for refeeding syndrome<\/li>\n\n\n\n<li>Collaboration with other treatment team members<\/li>\n\n\n\n<li>Review recommendations for exercise including modifications and risks<\/li>\n\n\n\n<li>Consider multi-vitamins, calcium and\/or vitamin D supplementation<\/li>\n\n\n\n<li>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.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Additional Considerations and Pearls&nbsp;<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Anorexia and Eating Disorders in Males &#8211; Symptoms in males may include:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Body image concerns- focus on muscularity\/definition<\/li>\n\n\n\n<li>Can present with desire to \u201cbulk up\u201d or fear of gaining weight<\/li>\n\n\n\n<li>Frequent thoughts about body fat percentage or body size<\/li>\n\n\n\n<li>Frequent thoughts about consuming or avoiding certain foods or entire food groups<\/li>\n\n\n\n<li>Checking nutritional information before eating any food items<\/li>\n\n\n\n<li>Driven to lose weight through extreme measures, e.g., excessive exercise, restricting food intake, purging, laxative use<\/li>\n\n\n\n<li>Persistent negative body image or body dysmorphia<\/li>\n\n\n\n<li>May obsess about their body size or having too much body fat<\/li>\n\n\n\n<li>High incidence of use\/misuse of nutritional supplements and steroids<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Complicated Presentation with Transgender and Other In LGBTQ+ Individuals<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Complex relationship with body image, fat and curves are \u201cweighted\u201d and complex, often result in disordered eating<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Complicated presentations including diabetes &amp; chronic disease, ASD and SUD; high risk and need for careful multidisciplinary collaboration<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Refeeding Syndrome \u2014 Characterized by hypophosphatemia and fluid\/electrolyte shifts \u2014 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 (&lt;70% median BMI or Target Weight)<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Special Consideration with Athletes<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">\u201cFemale Athlete Triad\u201d<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Menstrual Dysfunction, low available energy, decreased bone density.<\/li>\n\n\n\n<li>Heart rate &gt;50 warrants careful assessment&gt; malnutrition interferes with metabolism and energy demands.<\/li>\n\n\n\n<li>Exercise restrictions and return to play sports decisions<\/li>\n\n\n\n<li>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<\/li>\n\n\n\n<li>Return should be gradual and monitored\n<ul class=\"wp-block-list\">\n<li>2025 Female Triad Consensus Guidelines <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/41474492\/\">https:\/\/pubmed.ncbi.nlm.nih.gov\/41474492\/<\/a><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">\u201cMale Athlete Triad\u201d<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Energy deficiency\/low energy availability (with or without disordered eating)<\/li>\n\n\n\n<li>Suppression of the hypothalamic-pituitary-gonadal axis (functional hypogonadotropic hypogonadism), and<\/li>\n\n\n\n<li>Impaired bone health, osteoporosis or low bone mineral density with or without bone stress injury (BSI)<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Helpful Eating Disorders in Athletes Guideline<br><a href=\"https:\/\/www.nationaleatingdisorders.org\/eating-disorders-and-athletes-2\/\">https:\/\/www.nationaleatingdisorders.org\/eating-disorders-and-athletes-2\/<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">EDs occur across all cultural and racial backgrounds<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Neurodivergent individuals- at risk for ARFID as well as other eating disorders<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">ED patients always know more facts about food, but lots of misinformation<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Ask about internet use and eating and body image related websites visited<\/li>\n\n\n\n<li>PCP in ideal situation to teach about healthy nutrition<\/li>\n\n\n\n<li>\u201cFood is essential medicine\u201d for recovery from disordered eating<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">How to talk with patients and families<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Use clear, non-blaming language<\/li>\n\n\n\n<li>Educate and support. Do not argue or dictate.<\/li>\n\n\n\n<li>Eating disorders can be severe and are life threatening, even if the child appears healthy, or is an athlete<\/li>\n\n\n\n<li>Help patients and family to understand that just eating more does not work. Structured multidisciplinary treatment is required.<\/li>\n\n\n\n<li>Child and Family are an integral part of the treatment team<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">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.<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-esab-accordion-child\"><div class=\"esab__head\" role=\"button\" aria-expanded=\"false\"><div class=\"esab__heading_txt\"><p class=\"esab__heading_tag\">Resources<\/p><\/div><div class=\"esab__icon\"><div class=\"esab__collapse\"> <svg version=\"1.2\" viewBox=\"0 0 24 24\" width=\"24\" height=\"24\"><path fill-rule=\"evenodd\" d=\"m3.5 20.5c-4.7-4.7-4.7-12.3 0-17 4.7-4.7 12.3-4.7 17 0 4.6 4.7 4.6 12.3 0 17-4.7 4.6-12.3 4.6-17 0zm0.9-0.9c4.2 4.2 11 4.2 15.2 0 4.2-4.2 4.2-11 0-15.2-4.2-4.3-11-4.3-15.2 0-4.3 4.2-4.3 11 0 15.2z\"><\/path><path d=\"m11.4 15.9v-3.3h-3.3c-0.3 0-0.6-0.3-0.6-0.6 0-0.4 0.3-0.6 0.6-0.6h3.3v-3.3c0-0.3 0.3-0.6 0.6-0.6 0.3 0 0.6 0.3 0.6 0.6v3.3h3.3c0.3 0 0.6 0.2 0.6 0.6q0 0.2-0.2 0.4-0.2 0.2-0.4 0.2h-3.3v3.3q0 0.2-0.2 0.4-0.2 0.2-0.4 0.2c-0.4 0-0.6-0.3-0.6-0.6z\"><\/path><\/svg> <\/div><div class=\"esab__expand\"> <svg version=\"1.2\" viewBox=\"0 0 24 24\" width=\"24\" height=\"24\"><path fill-rule=\"evenodd\" d=\"m12 24c-6.6 0-12-5.4-12-12 0-6.6 5.4-12 12-12 6.6 0 12 5.4 12 12 0 6.6-5.4 12-12 12zm10.6-12c0-5.9-4.7-10.6-10.6-10.6-5.9 0-10.6 4.7-10.6 10.6 0 5.9 4.7 10.6 10.6 10.6 5.9 0 10.6-4.7 10.6-10.6z\"><\/path><path d=\"m5.6 11.3h12.8v1.4h-12.8z\"><\/path><\/svg> <\/div><\/div><\/div><div class=\"esab__body\">\n<h3 class=\"wp-block-heading\">Resources and Guidelines for Providers<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">ACCESS MENTAL HEALTH CT <a href=\"http:\/\/www.ACCESSMHCT.COM\">www.ACCESSMHCT.COM<\/a><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>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.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Recommended Guidelines AAP: Identification and Management of Eating Disorders in Children and Adolescents <a href=\"https:\/\/doi.org\/10.1542\/peds.2020-040279\">https:\/\/doi.org\/10.1542\/peds.2020-040279<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">AAFP <a href=\"https:\/\/www.aafp.org\/pubs\/afp\/issues\/2021\/0101\/p22.html\">https:\/\/www.aafp.org\/pubs\/afp\/issues\/2021\/0101\/p22.html<\/a> <a href=\"https:\/\/www.aafp.org\/pubs\/afp\/issues\/2021\/0101\/p22.html\">https:\/\/www.aafp.org\/pubs\/afp\/issues\/2021\/0101\/p22.html<\/a> JAMA Eating Disorders \u2013 A Review <a href=\"https:\/\/jamanetwork.com\/journals\/jama\/fullarticle\/2831140\">https:\/\/jamanetwork.com\/journals\/jama\/fullarticle\/2831140<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">UBC Comprehensive Toolkit (University of British Columbia) <a href=\"https:\/\/ubccpd.ca\/sites\/default\/files\/documents\/Eating-Disorders-Toolkit-for-PCP-2018.pdf\">https:\/\/ubccpd.ca\/sites\/default\/files\/documents\/Eating-Disorders-Toolkit-for-PCP-2018.pdf<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">NEDA Provider Resources:<br><a href=\"https:\/\/www.nationaleatingdisorders.org\/i-have-a-patient-with-an-eating-disorder\/\">https:\/\/www.nationaleatingdisorders.org\/i-have-a-patient-with-an-eating-disorder\/<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Other Resources<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Bright Futures <a href=\"https:\/\/www.brightfutures.org\/mentalhealth\/pdf\/bridges\/eat_disorder.pdf\">https:\/\/www.brightfutures.org\/mentalhealth\/pdf\/bridges\/eat_disorder.pdf<\/a><\/li>\n\n\n\n<li><span style=\"color: initial;\">Eating Disorders in Athletes<\/span><br><a href=\"https:\/\/www.nationaleatingdisorders.org\/eating-disorders-and-athletes-2\/\">https:\/\/www.nationaleatingdisorders.org\/eating-disorders-and-athletes-2\/<\/a><\/li>\n\n\n\n<li>CCMC (CT Children\u2019s Medical Center) Eating Disorders Clinical Pathway<br><a href=\"https:\/\/www.connecticutchildrens.org\/medical-professionals\/clinical-pathways\/eating-disorder\">https:\/\/www.connecticutchildrens.org\/medical-professionals\/clinical-pathways\/eating-disorder<\/a><\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Resources for Families and Patients<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>NEDA &#8211; <a href=\"https:\/\/www.nationaleatingdisorders.org\/help-someone\/\">https:\/\/www.nationaleatingdisorders.org\/help-someone\/<\/a><\/li>\n\n\n\n<li><span style=\"color: initial;\">AACAP Facts For Families- Teenagers with Eating Disorders<\/span><br><a href=\"https:\/\/www.aacap.org\/AACAP\/Families_and_Youth\/Facts_for_Families\/FFF-Guide\/Teenagers-With-Eating-Disorders-002.aspx\">https:\/\/www.aacap.org\/AACAP\/Families_and_Youth\/Facts_for_Families\/FFF-Guide\/Teenagers-With-Eating-Disorders-002.aspx<\/a><span style=\"color: initial;\"> <\/span><\/li>\n\n\n\n<li><span style=\"color: initial;\">Child Mind Institute<\/span><br><a href=\"https:\/\/childmind.org\/topics\/eating-eating-disorders\/?gad_source=1&amp;gad_campaignid=23770004383&amp;gbraid=0AAAAADxqHB95sIXDsFUg7a4hNdHcHO9cq&amp;gclid=Cj0KCQjw77bPBhC_ARIsAGAjjV8oWspxNQa6qI8IwpUazO0XTCttVesdof5_-3HNTSH0o0m__BjipL0aAs_FEALw_wcB\">https:\/\/childmind.org\/topics\/eating-eating-disorders\/?gad_source=1&amp;gad_campaignid=23770004383&amp;gbraid=0AAAAADxqHB95sIXDsFUg7a4hNdHcHO9cq&amp;gclid=Cj0KCQjw77bPBhC_ARIsAGAjjV8oWspxNQa6qI8IwpUazO0XTCttVesdof5_-3HNTSH0o0m__BjipL0aAs_FEALw_wcB<\/a><\/li>\n\n\n\n<li><span style=\"color: initial;\">NAMI CT<\/span><br><a href=\"https:\/\/namict.org\">https:\/\/namict.org<\/a><\/li>\n\n\n\n<li>F.E.A.S.T. (Families Empowered and Supporting Treatment of Eating Disorders)<br><a href=\"https:\/\/www.feast-ed.org\">https:\/\/www.feast-ed.org<\/a><\/li>\n\n\n\n<li>Patients with disordered eating <br><a href=\"https:\/\/www.nationaleatingdisorders.org\">https:\/\/www.nationaleatingdisorders.org<\/a> <\/li>\n\n\n\n<li>Books:<ul><li>ARFID Avoidant Restrictive Food Intake Disorder: A Guide for Parents and Carers (2019), by Rachel Bryant-Waugh<\/li><\/ul>\n<ul class=\"wp-block-list\">\n<li>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<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/div><\/div>\n<\/div><\/div>\n\n\n\n<div style=\"height:17px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h3 class=\"wp-block-heading\">References<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Golden NH, Katzman DK, Sawyer SM, Ornstein RM, Rome ES, Garber AK, Kohn M, Kreipe RE. Update on the medical management of eating disorders in adolescents. J Adolesc Health. 2015 Apr;56(4):370-5. doi: 10.1016\/j.jadohealth.2014.11.020. Epub 2015 Feb 7. PMID: 25659201.<\/li>\n\n\n\n<li>Hornberger LL, Lane MA, AAP THE COMMITTEE ON ADOLESCENCE. Identification and Management of Eating Disorders in Children and Adolescents. Pediatrics. 2021; 147(1):e2020040279 PEDIATRICS Volume 147, number 1, January <a href=\"https:\/\/doi.org\/10.1542\/peds.2020-040279\">https:\/\/doi.org\/10.1542\/peds.2020-040279<\/a><\/li>\n\n\n\n<li>Rosen DS; American Academy of Pediatrics Committee on Adolescence. Identification and management of eating disorders in children and adolescents. Pediatrics. 2010 Dec;126(6):1240-53. doi: 10.1542\/peds.2010-2821. Epub 2010 Nov 29. PMID: 21115584.<\/li>\n\n\n\n<li>Klein DA, Sylvester JE, Schvey NA. Eating Disorders in Primary Care: Diagnosis and Management. Am Fam Physician. 2021 Jan 1;103(1):22-32. Erratum in: Am Fam Physician. 2021 Mar 1;103(5):263. PMID: 33382560.<\/li>\n\n\n\n<li>Eating Disorders: A Guide to Medical Care from the Academy for Eating Disorders <a href=\"https:\/\/higherlogicdownload.s3.amazonaws.com\/AEDWEB\/27a3b69a-8aae-45b2-a04c-2a078d02145d\/UploadedImages\/Publications_Slider\/2120_AED_Medical_Care_4th_Ed_FINAL.pdf\">https:\/\/higherlogicdownload.s3.amazonaws.com\/AEDWEB\/27a3b69a-8aae-45b2-a04c-2a078d02145d\/UploadedImages\/Publications_Slider\/2120_AED_Medical_Care_4th_Ed_FINAL.pdf<\/a><\/li>\n\n\n\n<li>UBC Eating Disorder Toolkit <a href=\"https:\/\/ubccpd.ca\/sites\/default\/files\/documents\/Eating-Disorders-Toolkit-for-PCP-2018.pdf\">https:\/\/ubccpd.ca\/sites\/default\/files\/documents\/Eating-Disorders-Toolkit-for-PCP-2018.pdf<\/a><\/li>\n\n\n\n<li>AED Report 2021 | 4th edition. Eating disorders: A Guide to Medical Care <a href=\"https:\/\/nedc.com.au\/assets\/NEDC-Publications\/The-prevention-identification-and-response-to-eating-disorders-for-GPs_NEDC.pdf?2026042618\">https:\/\/nedc.com.au\/assets\/NEDC-Publications\/The-prevention-identification-and-response-to-eating-disorders-for-GPs_NEDC.pdf?2026042618<\/a><\/li>\n\n\n\n<li>Williams NI, De Souza MJ, et. al. 2025 Update to the Female Athlete Triad Coalition Consensus Statement Part 2: Clinical Guidelines for Screening, Diagnosis, Treatment, and Return to Play for Adolescents and Adults. Sports Med. 2026 Feb;56(2):375-427. doi: 10.1007\/s40279-025-02332-0. Epub 2025 Dec 31. PMID: 41474492; PMCID: PMC12982345.<\/li>\n\n\n\n<li>Cotton MA, Ball C, Robinson P. Four simple questions can help screen for eating disorders. J Gen Intern Med. 2003 Jan;18(1):53-6. doi: 10.1046\/j.1525-1497.2003.20374.x. PMID: 12534764; PMCID: PMC1494802.<\/li>\n\n\n\n<li>Pereira, R. F., &amp; Alvarenga, M. (2007). Disordered eating: Identifying, treating, preventing, and differentiating it from eating disorders.&nbsp;<em>Diabetes Spectrum<\/em>, 20(3), 141\u2013148.<a href=\"https:\/\/doi.org\/10.2337\/diaspect.20.3.141\" target=\"_blank\" rel=\"noreferrer noopener\">&nbsp;https:\/\/doi.org\/10.2337\/diaspect.20.3.141<\/a><\/li>\n\n\n\n<li>Attia E, Walsh BT. Eating Disorders: A Review. JAMA. 2025;333(14):1242\u20131252. doi:10.1001\/jama.2025.0132<\/li>\n\n\n\n<li>American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision. American Psychiatric Association Publishing; 2022.<\/li>\n\n\n\n<li>Fornaro&nbsp; M, Mondin&nbsp; AM, Billeci&nbsp; M,&nbsp; et al.&nbsp; Psychopharmacology of eating disorders: systematic review and meta-analysis of randomized controlled trials. &nbsp; J Affect Disord. 2023;338:526-545. doi:10.1016\/j.jad.2023.06.068<\/li>\n\n\n\n<li>Crone C, Fochtmann LJ, Attia E, et al. The American Psychiatric Association Practice Guideline for the Treatment of Patients With Eating Disorders. <em>The American Journal of Psychiatry.<\/em> 2023;180(2):167-171.doi:10.1176\/appi.ajp.23180001.<br><a href=\"https:\/\/doi.org\/10.1176\/appi.ajp.23180001\">https:\/\/doi.org\/10.1176\/appi.ajp.23180001<\/a><\/li>\n\n\n\n<li>Semchishen SN, H\u00f8jlund M, Lemaire D, Obeegadoo I, Hammond NG, Frangione B, Ogawa H, Sunderland R, Singh A, Wafy G, Campana M, Sakeah J, Brousseau K, Correll CU, Wagner E, Colman I, Solmi M. All-cause and cause-specific mortality risk in individuals with eating disorders: systematic review and meta-analysis of relative risk and aggravating or attenuating factors. World Psychiatry. 2026 Feb; 25(1):125-140. doi: 10.1002\/wps.70014. PMID: 41536100; PMCID: PMC12805073.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><em>** Special thanks to Mariela Podolski M.D. for her advice and assistance<\/em><\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Eating disorders are potentially life-threatening psychological disorders in which there are pathological eating and related behaviors, as well as disturbances in the experience of food and body, that cause distress and\/or impairment. Early intervention may decrease the risk of long-term pathology and disability. 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