FIGURE 2.

Algorithm of care for adolescents with anorexia nervosa (AN). The Delphi panel recommends FBT as the initial treatment for an adolescent with AN unless the patient is medically unstable, suicidal, refusing food, or at high risk for refeeding syndrome (FBT is also not recommended if there is parental abuse). Adolescents should be moved to inpatient treatment if any of these clinical features emerge during treatment in either FBT or a structured outpatient setting. Panel responses also suggest that other outpatient treatments may be added to FBT or recommended instead of FBT, if response to treatment is inadequate. Decrease in level of care from inpatient to FBT is suggested when the indication for hospitalization has resolved, and eating has improved. Decrease from inpatient to structured outpatient might be recommended if food intake is inadequate, or compensatory behaviors are not controlled. Empirical research is needed to determine specific weight criteria that warrant hospitalization and to determine clinical parameters (weight gain, eating improvement, medical, and psychiatric improvement) that indicate decreases in levels of care. For this algorithm, “inpatient” was defined as settings that provide 24 hours/7 days per week care (which may include residential) and “structured outpatient” was defined as treatment over multiple days per week and including supervised meals but not overnight care