Alternate adjunctive therapies such as equine therapy (based on the idea that caring for horses through grooming and other interactions is healing) may hold promise, although they are not evidence-based therapies.28 Mindfulness practices such as meditation and yoga benefit patients with anxiety and may provide low-energy physical activity.29. A BMI below 13.5 can lead to organ failure, while a BMI below 12 can be life-threatening. 2015;39:31). In patients with frequent purging or laxative abuse, the presence of electrolyte abnormalities requires prompt intervention. Anorexia nervosa is a complicated and complex eating disorder which can happen to both men and women. Sometimes, people stress about gaining weight. Addiction and recovery can cause people to isolate themselves from family members and loved ones. Anorexia nervosa (AN) is a severe mental disorder characterized by self-induced underweight (body mass index, BMI <17.5) and associated with serious medical complications, impairments in psychosocial functioning and psychiatric comorbidities [1,2,3].Chronic courses are common and mortality rates are high [4, 5].Due to the severity of the disorder a considerable proportion of individuals who . Adopting an exploratory classification comparing VE-AN, extreme AN (E-AN, BMI = 13.6-14.99), and NE-AN, no differences emerged between VE-AN and E-AN, while those with NE-AN reported significantly more impaired scores on all variables while the quality of life again did not differ across groups. This study describes the clinical features of anorexia nervosa patients requiring hospitalization in Japan. Neither the owners or employees of EatingDisorders.com nor the author(s) of site content take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading this site. The hospitalization in patients with anorexia nervosa has often a short-term success, as weight is restored to a healthy level, but high percentage of patients relapse during the first year following the discharge. There is an increased prevalence of anorexia nervosa and bulimia nervosa Positive answers to these questions often indicate anorexia nervosa or bulimia, a disorder characterized by binge eating and purging. The holidays are also, CBD vs THC: Differences in Properties, Benefits, and Effects, CBD and THC are cannabinoids derived from the Cannabis sativa plant, commonly called cannabis. Family-based treatment is helpful for adolescents with anorexia nervosa, whereas short-term psychotherapy, such as cognitive behavior therapy, is effective for most patients with bulimia nervosa. Further interest was given to the relationship between premorbid weight and . A psychotherapist or psychiatrist usually is involved. Eventually, they lose weight or cannot maintain an appropriate body weight based on their height, age, stature and physical health. The questions address if you've recently lost a notable amount of weight; your preoccupation with weight; whether you make yourself vomit after meals; the status of your menstrual cycle and if it's stopped; and ask about your image of fat vs. thin body types, especially your own. A BMI below 13.5 can lead to organ failure, and a BMI below 12 may be life-threatening. It's a way to evaluate whether a person is of normal weight, overweight or underweight. That being said, a BMI below 17.5 in adults is one of the common physical characteristics used to diagnose anorexia. Press question mark to learn the rest of the keyboard shortcuts, https://www.reddit.com/r/EDAnonymous/wiki/flair/. FOIA Click on a state below to find eating disorder treatment options that could be right for you. A longitudinal investigation of mortality in anorexia nervosa and bulimia nervosa. Epub 2012 Jan 24. However, the 20% relapse rate represents a significant clinical challenge, and the disorder is associated with an elevated all-cause standardized mortality ratio of 1.6 to 1.9.39,40. Family physicians can fill a central role in the monitoring and treatment of patients with eating disorders. Unable to load your collection due to an error, Unable to load your delegates due to an error. Examining the psychological and functioning correlates of DSM-5 eating disorder severity specifiers. Twin studies and other research suggest a genetic link.7 Eating disorders have been associated with abnormal neurotransmitter systems involving serotonin and dopamine.8,9 The role of hormones such as ghrelin, leptin, and oxytocin has also been investigated.10, Table 3 includes clinical signs of eating disorders.1113 Patients with eating disorders may often comment about being fat or not liking their body shape. A BMI below 13.5 can lead to organ failure, and a BMI below 12 may be life-threatening. Cannabinoids are chemical compounds that interact with the brain and can have a drug-like effect throu, The Sober Curious Movement: What It Is and What It Means, Are you one of the many people who noticed an uptick in your alcohol consumption during the pandemic? A severely underweight body and the unhealthy eating habits that go along with an eating disorder can have serious health consequences. Federal government websites often end in .gov or .mil. The DSM-5 diagnostic criteria for anorexia nervosa (Table 13 ) are similar to the previous DSM-IV criteria with respect to behavioral and psychological characteristics involving restriction of food intake resulting in low body weight, intense fear of gaining weight or becoming fat, and disturbance of body image.1,3 Notably, the DSM-5 criteria do not refer to a specific degree of weight loss required for the diagnosis, but instead provide guidelines for specifying the severity of weight loss. Epub 2014 May 13. The phrase "Enjoy the present and things we do" guides her daily life. Involuntary Hospitalization for Anorexia Nervosa Dec 2 Views: 183 One of the most daunting aspects of anorexia nervosa arises when a patient refuses treatment despite being seriously ill. Due to the egosyntonic nature of AN, a patient may feel the "disorder" is a part of her, and doesn't want it to go away. 8600 Rockville Pike Body mass index, or BMI, measures the relationship between height and weight. Statistics gathered by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) showed th, Overeaters Anonymous (OA) is an international program that aims to assist those who have compulsive eating issues. The main reason for inpatient hospitalization is medical instability. The validity of DSM-5 severity specifiers for anorexia nervosa, bulimia nervosa, and binge-eating disorder. -, Smith K.E., Ellison J.M., Crosby R.D., Engel S.G., Mitchell J.E., Crow S.J., Peterson C.B., Le Grange D., Wonderlich S.A. There is no obligation to enter treatment. from 18.5 to 24.9 your weight is within the normal range. A nutritionist will help an anorexic develop a healthy diet that includes enough calories to reach and maintain a healthy weight. What are the requirements for the diagnosis of anorexia? Restricting food intake deprives the body of valuable nutrients that support a healthy body, including strong bones, sexual function and brain health. Starvation wreaks havoc on the body as well as the psyche, and people with anorexia suffer from a long list of physical symptoms that, at their most severe, are . Even if the disorder is life-threatening, patients often refuse to be hospitalized, and are only admitted for treatment after pressure from clinicians, friends, teachers, or employers (Am J Psychiatry, 2007; 164:108). A severely underweight body and the unhealthy eating habits that go along with an eating disorder can have serious health consequences. At what BMI should a patient with anorexia be hospitalized? Bookshelf If your BMI below 18.5, this suggests that your weight may be too low. Before Careers. The .gov means its official. There is no single test that can be used to diagnose anorexia, and it is often present in conjunction with other mental health conditions such as depression, anxiety, and obsessive-compulsive disorder. 2006 Nov;189:428-32. doi: 10.1192/bjp.bp.105.018820. Treatment may require multiple healthcare providers, such as psychotherapists, nutritionists, and physicians. The current study focused on the associations between BMI standard deviation score (BMI-SDS) at admission and reasons for seeking inpatient treatment. official website and that any information you provide is encrypted Hypothalamic dysfunction, low fat stores, malnutrition, Electrolyte disorders, heart failure, prolonged corrected QT interval, Heart muscle wasting, associated with arrhythmias and sudden death (common in anorexia nervosa), Malnutrition, vitamin and mineral deficiencies, Thermoregulatory dysfunction, hypoglycemia, reduced fat tissue, Recurrent vomiting washes mouth with acid and stomach enzymes; mineral deficiencies, Laxative abuse, hypoproteinuria, electrolyte imbalances, Gastric acid and enzymes from vomiting cause parotid inflammation, Scars or calluses on fingers or hands (Russell sign [knuckle calluses]). Healthy BMI range: 18.5 - 25 kg/m 2 The result above is not a diagnosis Low BMI or body weight is just one physical feature of anorexia. Good BMI outcome [ Time Frame: 40 weeks after inpatient admission (corresponding to 20 weeks after discharge) ] Body Mass Index . For example, if: you are very low weight and you are still losing weight. 2010 Aug;55(1):147-51 The .gov means its official. Waist-to-height ratio (WHtR) A cousin of BMI, waist-to-height ratio compares, you guessed it, waist circumference with height, not total weight with height squared. A body weight that is 15 percent or more below average for height, age and gender indicates the possibility of the eating disorder. Oftentimes, getting straight answers from people with eating disorders is challenging. 2 As a result, eating disorder patients needing inpatient hospitalization are often admitted to specialized units rather than general psychiatric units where patients with other mental disorders are usually treated. Accessibility While there are clinical criteria for hospitalization for anorexia, the reasons for hospitalization are complicated and usually intertwined with clinical and psychiatric symptoms. Body weight in acute anorexia nervosa and at follow-up assessed with percentiles for the body mass index: implications of a low body weight at referral. The validity of body mass index (BMI) specifiers for anorexia nervosa (AN) has been questioned, but their applicability to inpatients with extremely low BMIs and their prognostic validity are currently unknown. If you need a tube and your BMI is that low, you need to go to treatment. Antidepressants, including selective serotonin reuptake inhibitors (SSRIs), may help mitigate symptoms of depression and suicidal ideation in patients with anorexia nervosa. [Guinness World Book of Records]. This condition is associated with a pro-inflammatory state; however, the role of immunity in symptom severity remains unclear. J Nutr Metab. There is no scientific consensus on the correct course of action. 2017;50:11091113. Criteria For Hospitalization For Anorexia, Response time about 1 min | Response rate 100%. Patient information: See related handout on eating disorders, written by the authors of this article. Copyright 2023 American Academy of Family Physicians. Methods Through retrospective chart review and . The experience of Guardia and colleagues with voluntary admission of 139 patients with eating disorders to Johns Hopkins Universitys eating disorders program provides interesting information (Am J Psychiatry. Body mass index (BMI) at hospital admission in patients with anorexia nervosa (AN) represents a prognostic marker for mortality, chronicity and future body weight. A person with anorexia nervosa may be in denial, and only a parent, friend or other loved one can convince her to seek treatment. An official website of the United States government. Int. The disorder is diagnosed when a person weighs at least 15% less than their normal/ideal body weight. Although approximately one-half of patients with anorexia nervosa fully recover, about 30% achieve only partial recovery, and 20% remain chronically ill.38 Anorexia nervosa has the highest mortality rate of any mental health disorder, with an estimated all-cause standardized mortality ratio of 1.7 to 5.9.39,40 The prognosis for bulimia nervosa is more favorable, with up to 80% of patients achieving remission with treatment. It was a very eye opening experience and not what I expected at all. If you are not sure how to correctly flair your post for trigger warnings, or how to add/edit post flair, please read our short guide by clicking here. At what BMI are anorexics hospitalized in the UK? Patients with anorexia may eat only 500 kcal a day, whereas the average daily caloric requirement for a sedentary adolescent is 1,800 kcal for females and 2,200 kcal for males.21 A reasonable initial target for weight restoration is 90% of the average weight expected for the patient's age, height, and sex.12,22 Growth charts are available from the Centers for Disease Control and Prevention at http://www.cdc.gov/growthcharts/charts.htm. As a result close friends and family members might try to persuade them to seek help. Eating Disorders Academy Recommends Inpatient Treatment for Everyone at or below 75% of their ideal body weight. A study found that approximately one-third of patients hospitalized for anorexia nervosa reported excessive (i.e., obligatory, obsessive, or driven) exercise during the three months before admission.15. B. Recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting; misuse oflaxatives, diuretics, or other medications; fasting; or excessive exercise. Frequent self-induced vomiting can contribute to parotitis, stained teeth or enamel erosions, and hand calluses. Laxative abuse causes hemorrhoids and rectal prolapse. Accompanying symptoms of bulimia (eating and vomiting), Diet addiction and a habit of limiting calories although body weight is already low, Distorted body image; someone with anorexia may be very thin but see fat when they look in the mirror, Feeling hungry but refusing to eat or eating very little, Preoccupation with food and eating habits of yourself and often others, Poor skin turgor (skin loses its elasticity), Heart rate falls below 40 beats per minute or above 110 beats per minute, Infection of any kind (anorexia can complicate a simple infection), Low serum potassium levels. Individuals with end-stage anorexia nervosa are very low weight (BMI less than 15), suffer from the physical and psychological effects of severe starvation, and require immediate life-saving medical interventions. The second component of treating anorexia could include outpatient treatment, but this is only possible for people who are not in serious medical danger. Patients who are involuntarily admitted for treatment are also much less likely to seek care after being discharged. Two formsof involuntary commitment areavailable in Connecticut, Maryland, Massachusetts and Tennessee, where court-ordered outpatient treatmenthasnot yet been adopted. Myths about "cleaning your plate" should be eliminated altogether, and children - even from a young age - should be allowed to learn how to self-regulate their hunger and the types of foods they eat. The program consists of 12 steps and is open to anyone who wants to join. While the signs of starvation or malnutrition might not land someone in the hospital for anorexia, its a fair assumption it is only a matter of time before it happens. Clinical BMI < 14 kg/m . No amount of dieting or weight loss can compensate or cure an eating disorder. Severe anorexia nervosa is defined in terms of weight as a person with a body mass index (BMI) <15 (BMI is weight in kilograms divided by height in meters squared). FOIA The authors note that there are few studies involving relatively small numbers of patients, and these studies show that short-term weight restoration does save patients and turn them around. However, the outcome shows that long-term follow-up shows that their outcomes are considerably worse than for patients who voluntarily seek treatment. Epigastric pain and a bloating sensation are common. Use spoilers to cover numbers in posts and comments. End-stage anorexia nervosa (AN) anorexia in its most severe form. evdjox 5 mo. Psychological symptoms include heightened emotional arousal, reduced tolerance of stress, emotional dysregulation, social withdrawal, and self-critical perfectionistic traits.3, Annual health supervision examinations and preparticipation sports physicals are ideal screening opportunities. [5]. As cachexia progresses, patients with anorexia nervosa lose strength and endurance, move more slowly, and demonstrate decreased performance in sports. Anorexia nervosa and bulimia nervosa occur most often in adolescent females and are often accompanied by depression and other comorbid psychiatric disorders. Thus, hospitalization should be considered for initial treatment of any seriously malnourished patient to allow for daily monitoring of key markers such as weight, heart rate, temperature, hydration, and serum phosphorus level.20. The level of severity may be increased to reflect other symptoms and the degree of functional disability. Lavoisy G, Guelfi JD, Vera L, Dardennes R, Rouillon F. Encephale. Eating disorders are very complicated and are most often the result of something much deeper. Involuntary treatment of an adolescent with AN is governed by the same laws that apply to other important decisions; parental consent is required as defined in common law. Most states require formal 504 plans that spell out special accommodations, such as snack breaks in class or allowances for missed school, to allow equal educational opportunities for students with medical disabilities. This content is owned by the AAFP. Earlier stability led to shorter hospital stays; people in the higher-calorie group were able to leave the hospital an average of 4 . Refusal of a person to try and maintain a normal body weight; fear of becoming fat; denial of the state of their body; and loss of menses for three months or longer are other behaviors indicative of anorexia. Strenuous physical activity and sports should be restricted. An interdisciplinary team approach is needed for the treatment of eating disorders, and often includes a family physician, a psychotherapist or psychiatrist, a dietitian, an eating disorder specialist, and school personnel. Healthy adults usually fall between 18.5 and 24.9 on the BMI chart. In young teens, a low BMI is not enough to diagnose anorexia nervosa. Michihata N, Matsui H, Fushimi K, Yasunaga H. Eat Weight Disord. A. Staff at these facilities can provide general accountability and support while the patient works to overcome their disorder. Epub 2020 Jul 14. Nutritional guidance focuses on healthy food intake and regaining the energy needed to resume activities. In this vide. Data Sources: Literature searches on Ovid Medline were performed. The main update in the DSM-5 criteria for bulimia nervosa (Table 23 ) is a decrease in the average frequency of bingeing and purging from twice to once a week.4, Bulimia nervosa affects four to six out of 200 females in the United States. Anorexia nervosa (AN) is a common eating disorder with the highest mortality rate of all psychiatric diseases. 2016; 49:407). Foppiani L, Cascio C, Pinto V, Lo Pinto G. Eat Weight Disord. Eat. Moderately low body weight is defined as BMI 1616.99. People with anorexia have an intense fear of becoming fat or are disgusted with the way their body looks. The World Health Organization (WHO) defines the BMI of a healthy adult as between 18.5 and 25.. A BMI less than 18.5 indicates underweight (possibly caused by illness, malnutrition, or eating disorders such as anorexia nervosa), and a BMI greater than 25 indicates overweight (possibly caused by poor diet choices or lack of exercise). This site needs JavaScript to work properly. They identified 669 eligible patients with anorexia (BMI 16.5) from 229 hospitals between July and December of that year. National Library of Medicine You can also edit a flair to customize it and have something like "TW / Topic". One of the main purposes of admission for anorexia nervosa is to manage acute medical conditions related to this condition. If psychotropic medications are attempted, the patient should be closely monitored, possibly in an inpatient or residential setting, and supervised by a psychiatrist or eating disorder specialist. The minimum level of severity is based, for adults, on current body mass index (BMI) (see below) or, for children and adolescents, on BMI percentile. Reprinted with permission from Campbell K, Peebles R. Mild : An average of bmi 18 5 anorexia definition episodes of inappropriate compensatory behaviors per week. It's not easy to navigate a new commitment to sobriety or recovery from substance use. Posted 7 years ago, 6 users are following. J. For example, body mass index (BMI) for age Z-scores < 2,0, > 1.0, > 2.0 and > 3.0 WHO recommends that children aged 05 years be classified as wasted, at risk of overweight, overweight and obese, respectively. The EatingDisorders.com helpline is free, private, and confidential. Epub 2017 Jun 17. Thus, involuntary admission may be futile or contraindicated for some persons with severe and enduring AN; these patients have impairments in quality of life that can equal those seen in patients with depression or schizophrenia. 2007; 164:106). The average BMI for women is approximately 26.8 and for men it is 26. BMI 13.5); and (c) to verify inpatients' hospitalization outcome according to BMI severity. Individuals with anorexia tend to control body weight through methods such as voluntary starvation, excessive exercise, or other weight control measures, including the use of diet pills or diuretics. The average body mass index was 13.1, and the in-hospital mortality rate was 0.7 %. 8600 Rockville Pike Centers for Disease Control and Prevention (growth charts), Families Empowered and Supporting Treatment of Eating Disorders, National Association of Anorexia Nervosa and Associated Disorders, Society for Adolescent Health and Medicine, Heart rate < 50 beats/min daytime; < 45 beats/min nighttime, Orthostatic changes in pulse (> 20 beats/min) or blood pressure (> 10 mm Hg), < 75% ideal body weight or ongoing weight loss despite intensive management, Failure to respond to outpatient treatment, Cardiac arrhythmias including prolonged QTc. More than 90 % of the patients were female and 100 patients were admitted involuntarily. doi: 10.1016/j.eatbeh.2018.07.006. Epub 2020 Jul 14. van den Berg JP, Elgersma HJ, Zeillemaker-Hoekstra M. BJA Educ. Vigorous debate continues over compulsory treatment of severely ill patients with AN. Calls are routed based on availability and geographic location. In some cases, EatingDisorders.com could charge a small cost per call, to a licensed treatment center, a paid advertiser, this allows EatingDisorders.com to offer free resources and information to those in need. Healthy adults usually fall between 18.5 and 24.9 on the BMI chart. Bradycardia, orthostatic hypotension, and palpitations may progress to potentially fatal arrhythmias. Whilst the peak age of anorexia nervosa is in the mid teens, most sufferers fall within the age range of adult services. Bethesda, MD 20894, Web Policies This AutoModerator function is still new and being messed with, so if it's working incorrectly/really annoying you, please let us know here. CDC weight chart for boy between age 2 and 20, CDC weight chart for girl between age 2 and 20. For the majority of people, a BMI of 17.5-18 is already underweight, but even if you had a BMI of 25, a starvation diet is going to cause major health problems. A type of binge/purging in which there are periods of eating that are offset by self-induced vomiting, laxative or diuretic abuse, and/or excessive exercise. Martini M, Longo P, Delsedime N, Abbate-Daga G, Panero M. J Clin Med. Celebrations throughout November, December, and even into January offer a myriad of opportunities to be around alcohol. Impact of somatic severity on long-term mortality in anorexia nervosa. The first thing to do in treating anorexia is to address any serious health issues and get a person stabilized. 2022 Oct;27(7):2569-2581. doi: 10.1007/s40519-022-01397-4. The validity of DSM-5 severity specifiers for anorexia nervosa, bulimia nervosa, and binge-eating disorder. Refeeding syndrome can occur in a malnourished individual when a rapid increase in food intake results in dramatic fluid and electrolyte shifts, and is potentially fatal. Three-fourths of the patients had comorbidities, and one-third had 2 or more comorbid conditions. Some doctors may show concern if BMI falls . Moreover, the exploratory subgroup of patients with BMI 13.5 did not delineate a clinically different group. Before the patient is weighed, a urine sample should be obtained to assess specific gravity for hydration status, pH level, ketone level, and signs of kidney damage. I use BMI instead of weight because, of course, height affects how much we can and do weigh. Int. Low weight is defined as less than minimally normal in adults (typically BMI less than 18.5) or minimally expected in children and young people (typically BMI-for-age less than the 5th percentile on an appropriate growth chart). The purpose of this study is to clarify which physical and social factors are related to the necessity for urgent hospitalization of anorexia nervosa (AN) patients in a long-term starvation state. Among psychiatric disorders, anorexia is the one with the highest mortality rate because of cardiac complications or suicide. Epub 2021 Aug 10. Subsequent Ovid Medline searches were conducted looking for specific topics such as zinc and eating disorders. Endocrine symptoms in anorexia nervosa include hypothermia (feeling cold), delayed onset of menses or secondary amenorrhea, and osteopenia progressing to osteoporosis.11,12, More than one-half of patients with eating disorders meet criteria for a current or past episode of major depression.16 Anorexia nervosa is associated with an increased risk of suicide, with the suicide standardized mortality ratio estimated to be as high as 31 in one meta-analysis.17 Other associated psychiatric disorders include obsessive-compulsive disorder, obsessive-compulsive personality disorder, social phobia, anxiety disorders, substance use disorders, and personality disorders. Please contact the moderators of this subreddit if you have any questions or concerns. Then, clinicians are faced with minimizing feelings of anger or breach of the therapeutic relationship. 2014 Dec;19(4):525-30. doi: 10.1007/s40519-014-0127-2. A person suffering from anorexia may not want to go to the hospital. . If your BMI is below 18.5, you are considered underweight.. The annual incidence of anorexia nervosa in men is less than 1 per 100,000 of population. Clinically, a person is considered too thin if their weight is considered underweight. Yes, they can get social services involved if your condition is bad enough. and transmitted securely. ), Newer global approaches search for neurobiological causes Anorexia nervosa still has one of the highest, It all began when US Senators Amy Klobuchar (D-MN), Shelley Moore Capito (R-WV), Tammy Baldwin, Anorexia nervosa has a longhistory. In addition to the role of environmental triggers and societal expectations of body size and shape, research has suggested that genes and discrete biochemical signals contribute to the development of eating disorders. For a diagnosis of anorexia nervosa according to the DSM-5, the following criteria must be met: Restriction of energy intake in relation to needs, resulting in significantly low body weight in the context of age, sex, developmental trajectory and physical health.. Review. What is the most severe case of anorexia? Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight. Anorexia Nervosa (AN) is a disabling disorder characterized by extreme weight loss and frequent chronicization, especially in its most severe forms. There should be a family focus on inner worth, not simply outer beauty, and the family's eating habits as a whole should be balanced and healthy. The first signs of an impending disorder may be subtle heightened concerns about diet and body weight. The laws also differ by location and by definitionfor example, in Israel and some parts of Australia, AN does not qualify as a mental illness warranting involuntary mental health admission and treatment. The site is secure. The information provided on EatingDisorders.com is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her health professional. Total cholesterol, white blood cells, neutrophils, lymphocytes, platelets, iron, folate, vitamin D and B12 were dosed in . cellemurph 5 mo. The lowest recorded BMI was 7.5 (she was only 21 inches tall and died of hypothermia), the highest BMI is around 188. official website and that any information you provide is encrypted Daily menus should include three full meals and a structured snack schedule that is monitored by parents or the school nurse. Anorexia nervosa: practical implications for the anaesthetist. The first signs and symptoms of anorexia are: Often the reasons for hospitalization of an individual with anorexia are intertwined with advanced anorexia symptoms. Clinical trials have shown significant improvement in bulimia nervosa with cognitive behavior therapy and interpersonal psychotherapy.27 Group therapy is used in many eating disorder treatment programs. Investigating the DSM-5 severity specifiers based on thinness for adults with anorexia nervosa.