The treatment of anorexia nervosa should begin with a comprehensive assessment, evaluating a person’s nutritional, medical and psychological needs [1424]. This process should be ongoing throughout treatment, as clinical needs and priorities of the client may change [870]. Clinical practice guidelines on the treatment of ED from the RANZCP [870, 1424, 1433] recommend that the initial assessment of anorexia nervosa incorporate the following information:
- Collection of a thorough history (including dietary restrictions, weight loss, disturbances in body image, fears about weight gain, bingeing, purging, excessive exercise, use of medications or AOD to lose weight or suppress appetite).
- Investigate medical complications and assess level of risk (physical exam to assess BMI, heart rate, blood pressure, temperature, metabolic tests, kidney function).
- Co-occurring psychiatric conditions.
- Cognitive changes due to starvation (e.g., slowed thought processing, difficulty concentrating).
- Possible contributing factors (e.g., family history of ED, developmental difficulties, dieting, or other weight loss causes).
It is suggested that these assessment factors be incorporated into a case formulation (discussed in Chapter B3), with treatment priorities based on a thorough risk assessment. Clinical guidelines recommend that treatment priorities follow client engagement (including psychoeducation, with family involvement, and MI) , medical stabilisation, reversal of the cognitive effects of starvation, and psychological treatment [870, 1427]. Where possible and practicable, it is recommended that people with anorexia nervosa requiring admission be treated at specialist ED units, or by professionals specialising in ED.