Referral Specialty for Eating Disorders
Patients with eating disorders should be referred to psychiatry, as eating disorders are psychiatric conditions requiring psychiatric evaluation and coordination of a multidisciplinary treatment team that incorporates medical, psychiatric, psychological, and nutritional expertise. 1, 2
Primary Specialty: Psychiatry
The American Psychiatric Association explicitly recommends that the initial evaluation of a patient with a possible eating disorder includes a psychiatric evaluation, and that psychiatrists should coordinate the comprehensive treatment plan. 1 This is because:
Eating disorders are fundamentally psychiatric diagnoses requiring specialized psychiatric assessment, including screening for co-occurring psychiatric disorders (depression, anxiety, obsessive-compulsive disorder, suicidal ideation). 1, 2, 3
Psychiatrists coordinate the multidisciplinary team, which is essential given that eating disorders require integration of medical, psychiatric, psychological, and nutritional expertise. 1, 2, 4
Disorder-specific psychotherapy is the cornerstone of treatment, with psychiatrists overseeing eating disorder-focused cognitive behavioral therapy for bulimia nervosa and binge-eating disorder, and family-based treatment for adolescents with anorexia nervosa. 2, 5, 6
Essential Multidisciplinary Team Members
While psychiatry is the primary referral specialty, effective treatment requires coordination with:
Medical physicians (internists or family physicians) to manage medical complications including cardiac arrhythmias, electrolyte abnormalities, and refeeding syndrome risk, as up to one-third of deaths in anorexia nervosa are cardiac-related. 2, 3
Registered dietitians/nutritionists to provide nutritional rehabilitation, set individualized weekly weight gain goals, and address eating behaviors. 2, 4, 7
Psychotherapists trained in eating disorder-focused therapies to deliver cognitive behavioral therapy or family-based treatment. 1, 2, 5
Critical Pitfall to Avoid
Do not refer to primary care alone for initial management. While primary care physicians can identify eating disorders and initiate basic medical workup, the complexity of these conditions—including the 25% suicide rate in anorexia nervosa and high medical mortality—requires psychiatric expertise for proper evaluation and treatment coordination. 2, 3, 7 Primary care involvement is essential for medical monitoring but should occur within a psychiatrist-coordinated multidisciplinary framework. 7
When Immediate Medical Hospitalization Precedes Psychiatric Referral
Patients with severe medical instability (severe bradycardia, QTc prolongation, severe electrolyte abnormalities, or signs of refeeding syndrome) require immediate medical hospitalization before psychiatric referral, as these are life-threatening emergencies. 2, 8 However, even in these cases, psychiatric consultation should occur during the medical hospitalization, and transfer to a specialized eating disorder program under psychiatric coordination should follow medical stabilization. 2, 8