France bans extremely thin models
Detection, Evaluation, and Treatment of Eating Disorders
Initial Evaluation, Diagnosis, and Treatment of Anorexia Nervosa and Bulimia Nervosa
How does a healthcare professional evaluate for anorexia?
A qualified healthcare professional will use a variety of assessment tools to establish an accurate diagnosis, assess for complications, and determine an appropriate course of treatment. An assessment can last anywhere from one hour to several office visits, depending on the complexity of the diagnostic picture. Frequently, a multidisciplinary team approach is used to provide a comprehensive assessment. For example, a qualified mental health professional may conduct a thorough diagnostic interview to establish a person’s history of eating disorder symptoms, determine if symptoms meet the diagnostic criteria for an eating disorder, evaluate current stressors, and assess for any co-occurring psychiatric conditions. In addition, a physician will evaluate physical health status and assess the risk of physical complications. A dietitian may be called upon to evaluate nutritional needs and deficiencies.
A comprehensive assessment may also include members of the patient’s family, especially when the patient is still living at home, in order to provide collateral information, screen for a family history of eating disorders or other conditions, identify relevant family stressors, and provide the family with recovery support.
The treatment team may utilise a variety of professional tools during an evaluation. In addition to a clinical or diagnostic interview, healthcare professionals may use structured assessment instruments to assist with diagnosis and treatment planning. The Eating Disorder Examination, developed by Zafra Cooper and Christopher Fairburn, is one of the most widely used professional assessment instruments for eating disorders. Other popular assessment instruments are “self-report” in nature, meaning they are completed by patients and then returned to their treatment professionals, who incorporate the self-report data into the overall assessment and treatment plan. Self-report measures are used not only to help verify a clinical diagnosis but also to help track changes in eating disorder symptoms over time. Examples of self-report measures include the Eating Disorder Inventory and the Eating Disorder Examination–Questionnaire. The most widely used self-report screening tool for eating disorders is the Eating Attitudes Test (EAT-26). The EAT-26 alone is not designed to make a diagnosis of an eating disorder or to take the place of a professional diagnosis or consultation; only a qualified healthcare professional can provide an accurate diagnosis. However, the EAT-26 can be a first step in the screening process and can be useful for assessing eating disorder risk. (Note: All self-report measures require open and honest responses in order to gain accurate information. The fact that most people provide honest responses means the EAT-26 and other self-report measures usually offer very useful information about the eating symptoms and concerns common in eating disorders.)
What kinds of questions will I be asked during my assessment?
In the course of a comprehensive assessment, members of your treatment team will likely ask you most of the questions found in the following list. Keep in mind that your participation in any assessment interview is voluntary, and you can let your healthcare professional know if any of the questions make you uncomfortable, if you wish to return to a question later, or if you prefer not to answer. You have the right to feel comfortable with the assessment process as well as with the professional conducting the interview. By the same token, keep in mind that your treatment team will be able to take the best approach to your recovery when they are informed thoroughly about your history and symptoms.
Questions you may be asked include:
• Your age, marital status, and occupation
• Your education history
• Whether you have been in treatment before
• What concerns motivated you to seek help
• Dieting and weight history
• Your thoughts about food, eating, and weight gain
• Duration and intensity of eating disorder signs and symptoms
• Use of diet pills, laxatives, diuretics, or emetics
• Exercise patterns
• Your perceived body image
• Your developmental history
• Your general health history
• Your family’s health history
• Any medications you take or allergies to any medications (including supplements)
• Your menstrual history (for females)
• Your energy level and sleep patterns
• Questions about your academic, social, occupational, and family functioning
• History of teasing or peer pressure
• Past or present drug or alcohol use
• Past or present physical, sexual, or emotional abuse
• Your personality, interests, and hobbies
• Questions to screen for anxiety, depression, suicidal thoughts/intent, and self-injurious behaviour
• Questions to screen for other mental and physical disorders
If present, your family may be asked about family communication style, family relationships, general family history, your developmental history, and their observations of your eating disorder symptoms.
What kinds of laboratory tests will my physician conduct during the assessment?
In addition to measuring your heart rate, blood pressure, and body temperature, your physician will want to conduct routine laboratory tests used to evaluate general physical health and may also want to screen for physical complications common to eating disorders. Laboratory tests may include:
• A basic blood analysis, which evaluates such things as electrolyte levels, blood urea nitrogen (BUN), creatinine level, blood glucose levels, and thyroid hormone level; this also provides a complete blood cell count (CBC), which checks for infection, anaemia, and
immune system functioning. Other markers of liver and kidney function can also be measured by a blood test.
• A urinalysis.
• An electrocardiograph (ECG), which records the electrical activity of the heart over time and is used to assess any abnormal rhythms of the heart muscle.
• Bone density tests.
• Hormone level assessments (for both males and females).
• Drug use screening, as indicated.
• Other tests as indicated, including a pregnancy test, chest x-ray, heart stress test, and MRI.
• Additional tests may be required when symptoms of other physical illness or complications are present.
Terms:
Multidisciplinary – Two or more professional disciplines working collaboratively. In health care, it refers to delivery of services by professionals from a variety of healthcare specialities.
Diagnostic interview – A structured or semi-structured interview of a patient, conducted by a healthcare professional in order to establish an accurate diagnosis of illness or condition.
Blood urea nitrogen (BUN) – A blood test that helps to assess kidney function by measuring a waste product excreted by the kidneys.
Creatinine – A waste substance produced by the muscles. Measuring the creatinine level in the blood gives an indication of kidney functioning.
