Eating-disorders dossier — APA 2023 + AED 2016 Garber Medical Management of Severely Restrictive Eating Disorders + NICE NG69 2023 + Maudsley FBT (Lock & Le Grange 2013) + CBT-E (Fairburn 2008) Covers AN-R (F50.01), AN-BP (F50.02), BN (F50.2), BED (F50.81), ARFID (F50.82), OSFED (F50.89 — includes atypical AN), pica (F50.83), rumination (F50.84); AN lifetime ~0.5-2% F (M:F ~1:10); BN ~1-3% F; BED ~1-3% (less gender-skewed); ARFID ~0.5-3% pediatric; OSFED most common ED in primary care AN carries the HIGHEST MORTALITY of any psychiatric disorder (SMR ~5-6× per Arcelus 2011 NEEDS_SOURCE_REVIEW; Fichter 2016 NEEDS_SOURCE_REVIEW); 4-5× completed-suicide rate per population; AN-BP + BN highest SI rates among EDs Step 1 BN: fluoxetine 60 mg/d FDA-approved (Walsh JAMA 1997 PMID 9215413); higher than typical MDD dose; combination with CBT-E superior to either alone Step 2 BED: lisdexamfetamine 30-70 mg/d FDA-approved Schedule II (McElroy JAMA Psychiatry 2015 PMID 25587642); informed consent on abuse / dependence / CV risks; BP / HR baseline + monitoring; pre-screen CV history; NEVER in AN; NEVER with current/recent MAOI; topiramate 25-200 mg/d off-label alternative (pregnancy test FIRST — FDA Cat D) Step 3 AN: olanzapine 2.5-10 mg QHS off-label adjunct (Attia Am J Psych 2019 PMID 30958539); modest BMI gain over 16 wk; metabolic burden REAL — A1c + lipids + weight baseline + Q3-6 mo (APA/ADA 2004); never as monotherapy without ED-specific psychotherapy Step 4 comorbid MDD/anxiety AFTER weight restoration: sertraline 25-200 (preferred lactation) OR escitalopram 5-10-20 (Cipriani 2018 PMID 29477251); Walsh JAMA 2006 NEEDS_SOURCE_REVIEW — SSRI NOT effective in low-weight AN; defer SSRI in AN until weight restoration to ~85% IBW Refeeding-syndrome protocol axis (AED 2016 Garber): start 5-10 kcal/kg/d + thiamine 100 mg IV/PO × 5-7 d + daily Phos/Mg/K replacement + ECG monitoring; advance 5-10 kcal/kg/d Q1-2 d as labs allow; target 30-40 kcal/kg/d for weight restoration; NG-tube acceptable bridge but requires concurrent ED-psychotherapy plan Acute medical stabilization axis: AED 2016 Garber admission criteria — HR < 40, QTc > 470, K < 3.0, Phos < 2.5, Mg < 1.5, weight < 75% IBW or BMI < 14, hypothermia < 36.0°C, severe orthostatic SBP drop > 20 mm Hg or pulse rise > 20, acute SI, refeeding-syndrome risk CRITICAL anti-patterns: NEVER feed at full caloric needs in severe AN — refeeding syndrome risk; NEVER initiate SSRI in low-weight AN expecting weight restoration (Walsh JAMA 2006); NEVER prescribe bupropion in active purging behavior (seizure); NEVER use stimulants in active AN-R; NEVER ignore QTc > 470 in AN/BN; NEVER abruptly discontinue SSRI/SNRI (Horowitz hyperbolic taper); NEVER omit C-SSRS in ED patient; NEVER omit refeeding-syndrome risk screen on admission; NEVER initiate olanzapine without metabolic baseline; NEVER omit DEXA in chronic AN ≥ 6 mo amenorrhea; NEVER prescribe estrogen for AN bone loss (Misra 2017); NEVER discharge active-SI patient without inpatient bed OR safety plan; NEVER feed exclusively NG-tube without psychotherapy commitment; NEVER omit pregnancy test before starting topiramate; NEVER omit MDQ before SSRI in suggestive features; NEVER counsel BN patient to brush teeth immediately after purging; NEVER use IV potassium > 10 mEq/hr peripherally without ECG monitor; NEVER feed via NG when patient at imminent refeeding risk without thiamine pre-load Severity triggers (10): severe_an_with_medical_instability (life-threatening — AED 2016 Garber admission criteria + telemetry + AED refeeding protocol), refeeding_syndrome_risk_at_admit (life-threatening — start 5-10 kcal/kg/d + thiamine + daily Phos/Mg/K), severe_bn_with_electrolyte_disturbance (severe — K < 3.0 + ECG + IV replacement + SSRI deferred), eating_disorder_with_acute_suicidality (life-threatening — routes to psych.suicidality.ed.core.v1), pediatric_adolescent_an_with_weight_loss_velocity (severe — > 5% in 3 mo OR < 5th BMI percentile + FBT first-line), dental_erosion_and_parotid_in_bn (moderate — dental + ENT + DO NOT brush teeth post-purge), osteoporosis_from_an_chronic (moderate — weight restoration primary + calcium + vitamin D; estrogen NOT effective), pregnancy_with_eating_disorder_history (severe — MFM + sertraline acceptable + bupropion CONTRAINDICATED + olanzapine/lisdexamfetamine risk-benefit), treatment_resistant_an_chronic_severe (severe — SE-AN framework per Hay 2012 + harm-reduction + olanzapine + long-term outpatient), bed_with_metabolic_comorbidity (moderate — lisdexamfetamine 30-70 mg + CBT-E + endo/nutrition + routes to endo.dm2.core.v1) Two setting playbooks: outpatient (psych + nutrition + therapy; FBT for adolescents, CBT-E for adults; weekly weight + BMP + ECG + SCOFF + EDE-Q + PHQ-9 + GAD-7 + C-SSRS cadence; Horowitz hyperbolic taper; MDQ pre-SSRI; DEXA Q1-2 yr; dental Q6 mo in BN) + inpatient medical (AED 2016 Garber admission criteria; refeeding protocol; telemetry; daily Phos/Mg/K + ECG; 1:1 sitter for SI or active purging; activity restriction; bathroom supervision in BN); IOP/PHP/residential ED program + outpatient-post-stabilization encoded indirectly via escalation_triggers + disposition_criteria Action plan green/yellow/red includes ED self-management coping (meal-plan adherence; binge/purge urge coping; grounding; distraction), trauma-trigger coping, medical-instability red-flags (fainting/chest pain/palpitations/blood in vomit/severe abdominal pain), Stanley-Brown safety plan, 988 lifeline, family/supports engagement Sibling differentiation: psych.depression.core.v1 (~50-70% comorbid MDD AN, ~50% BN; SSRI deferred in low-weight AN per Walsh JAMA 2006; fluoxetine 60 mg/d FDA-approved BN), psych.anxiety-disorders.core.v1 (~50% comorbid anxiety; OCD ~35% AN-R; social anxiety ~35%; cross-route for OCD-spectrum), psych.suicidality.ed.core.v1 (active SI cross-route; compose not replace; AN 4-5× completed-suicide), psych.bipolar-disorder.core.v1 (MDQ before SSRI; switch caution), psych.alcohol_withdrawal.core.v1 (~50% AUD in BN with purging; bupropion CONTRAINDICATED in active purging seizure), psych.opioid_use_disorder.core.v1 (CRITICAL: NEVER benzo + opioid per FDA 2016 black-box), endo.dm2.core.v1 (BED + T2DM coordination; lisdexamfetamine + GLP-1 / SGLT2i dual benefit), id.sepsis.core.v1 (severe AN immunocompromise; lower detection threshold) Front-end note: no existing ED-specific panel surface in src/components/panels/ob-peds-psych/ today; this dossier is the back-end pathway pack. SCOFF / EDE-Q / EAT-26 panel surfaces flagged for future wire-up batch. Workup IDs all resolve to registered umbrellas in clinical-tools-registry — workup.suicide_risk + workup.severe_agitation + workup.hyperthermic_toxidromes + workup.chest_pain + workup.insomnia. Calculator IDs all resolve to registered tools — calc.phq9 + calc.gad7 + calc.audit_c + calc.ckd_epi_2021. calc.scoff + calc.edeq + calc.eat26 + calc.cssrs + calc.mdq flagged for future clinical-tools-registry batch — referenced via narrative + workup.suicide_risk for now. Phenotype matrix (ed_type × severity × age × duration × treatment_history × comorbidity × pregnancy × medical_complications × suicidality_cssrs) is encoded indirectly via severity_triggers + setting_playbooks + sibling_differentiation. First-class TS field for phenotype matrix is schema-blocked — see docs/framework-audit/shard-5-obped-id-state.md Schema-blocked queue. Bayesian linkage (SCOFF ≥ 2 LR+ ~4-7 per Morgan 1999 PMID 10688783; SCOFF ≥ 3 LR+ ~10; EDE-Q ≥ 4 LR+ ~8; BMI < 5th percentile-for-age LR+ ~10 in adolescents; weight-loss velocity > 5% in 3 mo flags atypical AN even at normal BMI; HR < 40 telemetry-indicated; QTc > 470 Long-QT risk after correcting K/Mg/Phos; K < 3.0 + Phos < 2.5 + Mg < 1.5 = AED 2016 Garber admission criteria; PHQ-9 ≥ 10 LR+ ~7 for comorbid MDD ~50-70% AN ~50% BN; MDQ positive LR+ ~7 in psych outpatients; C-SSRS gradient anchors disposition; AN 4-5× completed-suicide; T_treat = DSM-5-TR ED diagnosis + functional impairment OR medical instability; T_test = SCOFF ≥ 1 + EDE-Q < 4 + no functional impairment + no medical instability + supportive environment; T_admit_medical = AED 2016 Garber criteria; T_PHP_residential = outpatient stalled + medically stable + ≥ 8-12 wk; T_outpatient_post_stabilization = medically stable + safe discharge; T_switch = fluoxetine BN 60 mg × 8 wk failed; T_augment = BED on lisdexamfetamine + CBT-E inadequate → topiramate off-label; T_taper_SSRI = Horowitz hyperbolic; cross-dossier routing to psych.depression + psych.anxiety-disorders + psych.suicidality.ed + psych.bipolar-disorder + psych.alcohol_withdrawal + psych.opioid_use_disorder + endo.dm2 + id.sepsis documented in co-located research bundle). ROS/DDx LR seed data audited by npm run audit:ros-ddx-coverage (cross-cutting; not touched by this shard). PRODUCTION blockers / open gaps: (1) RxCUIs not yet validated via scripts/research/rxnav-validate.ts; lisdexamfetamine RxCUI 1148486 referenced by label NEEDS_RXNAV_VALIDATION; (2) manifest reuses psych.depression.core.v1.ts pointer per peds.febrile-infant / psych.bipolar / psych.alcohol_withdrawal / psych.suicidality / psych.anxiety-disorders / psych.ptsd precedent — dedicated manifest out-of-shard-scope; (3) calc.scoff + calc.edeq + calc.eat26 + calc.cssrs + calc.mdq not in clinical-tools-registry — referenced via workup.suicide_risk + narrative; (4) APA 2023 ED guideline + AED 2016 Garber + NICE NG69 2023 + Lock & Le Grange 2013 FBT manual + Fairburn 2008 CBT-E manual + Walsh JAMA 2006 fluoxetine-AN-low-weight-negative + Misra Bone 2017 estrogen-AN + Hay BMC Psychiatry 2012 SE-AN + Lock 2010 Arch Gen Psych FBT-RCT + Horowitz Lancet Psych 2019 + Hirschfeld MDQ 2000 + Beers 2023 + Boyer NEJM 2005 + Stanley-Brown 2012 + Mann JAMA 2005 + Arcelus 2011 mortality + Fichter 2016 mortality + McElroy Biol Psychiatry 2007 topiramate-BED PMIDs NEEDS_SOURCE_REVIEW — referenced by label only; not added to evidence.pmids per verification rule; (5) targeted test file pending (relies on dossier-contract.test.ts); (6) panel→dossier wire (SCOFF / EDE-Q / EAT-26 panel) not authored — flagged for future wire-up batch; (7) FBT phase-specific protocol detail + CBT-E focused vs broad detail currently encoded as inline non-drug language only — not first-class non-drug action atoms; (8) pediatric AN < 12 yr standalone deferred to future peds.feeding-disorder.v1.