Eating Disorders

The clinician managing eating disorders makes critical decisions regarding level of care, medical stabilization, pharmacotherapy, and coordination of the multidisciplinary treatment team. Level-of-care determination uses the APA Practice Guidelines and ASAM-like criteria: inpatient medical hospitalization (BMI below 15, HR below 40, syncope, severe electrolyte abnormalities, refeeding syndrome risk), residential eating disorder treatment (medical stability but unable to manage eating in less structured setting), partial hospitalization (stepping down from residential, needs meal supervision but medically stable), intensive outpatient (3+ days/week group therapy with meal support), and outpatient (weekly individual therapy with dietitian). Pharmacotherapy in eating disorders is limited: NO medication is FDA-approved for AN (SSRIs may help prevent relapse after weight restoration but are ineffective during acute starvation); fluoxetine 60 mg is the ONLY medication FDA-approved for BN; lisdexamfetamine 50-70 mg is the ONLY medication FDA-approved for BED. The clinician manages medical complications including: cardiac monitoring and electrolyte management, osteoporosis screening and management, reproductive health (amenorrhea evaluation, fertility counseling), endocrine abnormalities (sick euthyroid syndrome, hypercortisolism, growth hormone resistance), and GI complications (gastroparesis from AN, constipation, SMA syndrome, pancreatitis).