August 6, 1999

The APA Board of Trustees has approved a revised version of the Practice Guideline for Treatment of Patients With Eating Disorders, incorporating changes that reflect the weight of clinical consensus as well as scientific data.

The Board approved the revision at its July meeting in Washington, D.C., and it will be published in the American Journal of Psychiatry in an issue to be announced. The original guideline was approved in February 1993. APA plans to revise its guidelines every five to six years, according to Joel Yager, M.D., who chaired the APA Work Group on Eating Disorders for both the original and revised guideline. Yager is a professor of psychiatry at the University of New Mexico School of Medicine in Albuquerque.

The revised practice guideline "will be of great benefit to the field," said Yager. Its "substantial revisions" are based on input from not only the work group, but "a large group of national and international authorities and a considerable number of practitioners who have served as liaisons and consultants to APA's process," Yager added.

Among the revisions approved by the Board were a number that reflected the importance of clinical consensus and the role of psychodynamic psychotherapy.

Yager noted that "several innovations mark the revised guideline." He called attention to a table in the guideline titled "Suggested Guidelines for Levels of Care," adopted from a working document composed by a panel from the Academy for Eating Disorders. The table includes recommendations for what might constitute "necessary and sufficient" reasons to choose various levels of care, including inpatient, partial (full day outpatient), intensive outpatient, or outpatient levels, Yager said. The table considers variables including medical complications, suicidality, weight loss and rate of weight loss, and motivation to recover. The guideline includes another list of contributing factors to be considered with regard to decisions about treatment setting, he added. "This section of the guideline may be particularly helpful for clinicians and families dealing with insurance coverage issues."

The guideline also "spells out what constitutes psychiatric management for eating disorders and offers recommendations for interdisciplinary team work in caring for these patients," Yager said. It looks at cases that "don't neatly fall into either the anorexia nervosa or bulimia nervosa category, including the research category of binge- eating disorder."

The text also deals with problems specific to eating disorders in very young and older patients, male patients, pregnant patients, diabetic patients, and athletes. Common comorbid conditions are also addressed.

An extensively revised and updated literature review features about 400 citations.