These guidelines are for the clinical management of eating disorders They are intended to provide current evidence based guidance on the assessment and treatment of people with eating disorders by psychiatrists and other health professionals in the Australian and New Zealand context and includes identifying further research needs.
The first of these Guidelines, written by a series of expert Advisory Panels, and endorsed by the Royal Australian and New Zealand College of Psychiatrists, is now available online.
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Why are these Guidelines so important?
- These are the first guidelines to incorporate DSM-5 and the new disorder of ARFID
- They include consideration of recovery-orientated practice
- A special focus on anorexia nervosa, clearly showing the significant progress made in evidence-based treatments especially with specialist psychological therapies. The Guidelines look at the condition across the lifespan, and feature a section on severe and enduring cases.
- The Guidelines are evidence-based, multidisciplinary, and have been compiled with extensive community and stakeholder consultation.
Forthcoming Clinical Consensus Guidelines:
Objectives: This clinical practice guideline for treatment of DSM-5 feeding and eating disorders was conducted as part of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) Clinical Practice Guidelines (CPG) Project 2013–2014.
Methods: The CPG was developed in accordance with best practice according to the National Health and Medical Research Council of Australia. Literature of evidence for treatments of anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), other specified and unspecified eating disorders and avoidant restrictive food intake disorder (ARFID) was sourced from the previous RANZCP CPG reviews (dated to 2009) and updated with a systematic review (dated 2008–2013). A multidisciplinary working group wrote the draft CPG, which then underwent expert, community and stakeholder consultation, during which process additional evidence was identified.
Results: In AN the CPG recommends treatment as an outpatient or day patient in most instances (i.e. in the least restrictive environment), with hospital admission for those at risk of medical and/or psychological compromise. A multi-axial and collaborative approach is recommended, including consideration of nutritional, medical and psychological aspects, the use of family based therapies in younger people and specialist therapist-led manualised based psychological therapies in all age groups and that include longer-term follow-up. A harm minimisation approach is recommended in chronic AN. In BN and BED the CPG recommends an individual psychological therapy for which the best evidence is for therapist-led cognitive behavioural therapy (CBT).
There is also a role for CBT adapted for internet delivery, or CBT in a non-specialist guided self-help form. Medications that
may be helpful either as an adjunctive or alternative treatment option include an antidepressant, topiramate, or orlistat (the last for people with comorbid obesity). No specific treatment is recommended for ARFID as there are no trials to guide practice.
Conclusions: Specific evidence based psychological and pharmacological treatments are recommended for most eating disorders but more trials are needed for specific therapies in AN, and research is urgently needed for all aspects of ARFID assessment and management.
Phillipa Hay, David Chinn, David Forbes, Sloane Madden, Richard Newton, Lois Sugenor, Stephen Touyz, and Warren Ward
Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of eating disorders Aust N Z J Psychiatry November 2014 48: 977-1008, doi:10.1177/0004867414555814