Brazilian Psychiatric Association guidelines for the treatment of eating disorders.

Abstract

Eating disorders (ED), such as anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED), are serious psychiatric conditions that significantly impact psychological and medical health. This paper aims to summarize the recommendations of the Brazilian Association of Psychiatry - [Associação Brasileira de Psiquiatria (ABP)] for the treatment of EDs, based on the latest available evidence. Systematic reviews focused on the multidisciplinary treatment of ED were conducted. Findings were evaluated based on evidence strength, and recommendations using the evidence-based methodology of the Oxford Centre for Evidence-Based Medicine, finalized by an expert panel consensus. A summary of the recommendations and their corresponding levels of evidence was produced. Overall, the management of AN should use the least restrictive setting, combining monitored nutritional rehabilitation with psychotherapy. Pharmacotherapy plays a limited role in selected cases. BN is typically managed in an outpatient setting, focusing on structured nutritional care and CBT-based treatment, with pharmacotherapy adjunctive, preferably fluoxetine. BED is treated in an outpatient setting with structured care and CBT, with lisdexamfetamine as the preferred pharmacotherapy when needed. These guidelines represent a significant advancement in managing eating disorders in Brazil, providing a structured framework for clinical care while also supporting the development of future public mental health policies.