Algorithm for disposition of medically stable adults who initially present with anorexia nervosa*

* For a definition of medical stability in anorexia nervosa, refer to UpToDate topic on evaluating patients with anorexia nervosa for medical complications. Patients with a body mass index <15 kg/m² should generally initiate treatment as an inpatient rather than in partial hospital or outpatient clinic. Treatment may be less effective if higher levels of care are postponed until patients manifest more severe symptoms, and refeeding in these circumstances is associated with greater risks.
¶ Symptoms of suicidal ideation and behavior typically supersede symptoms of anorexia nervosa in determining the level of care. Refer to UpToDate topic on suicidal ideation and behavior in adults for assessing suicidality and determining level of care.
Δ Refer to UpToDate topic on clinical manifestations, assessment, and diagnosis of anorexia nervosa. As an example, one symptom is restricted energy intake leading to low body weight. Mild to moderate low body weight is a body mass index of 16 to 18.4 kg/m². A severely low body weight is a body mass index <16 kg/m².
◊ Refer to UpToDate topic on clinical manifestations, assessment, and diagnosis of anorexia nervosa for common comorbid psychopathology. As an example, severe major depression is characterized by a score on the 9-item Patient Health Questionnaire ≥20.
§ Generally inpatient hospitalization is required. However, if both a comprehensive partial hospital program devoted to eating disorders and adequate family resources to provide consistent supervision at other times are both available, partial hospital can be sufficient.

¥ If family and friends provide supervision rather than clinicians, family and friends need to be consistently available.

‡ Generally partial hospital is required. However, if adequate family resources are available to provide consistent supervision, outpatient care can be sufficient.