Test and Diagnosis of Eating Disorders
Eating disorders are a group of serious conditions in which you’re so preoccupied with food and weight that you can often focus on little else. The main types of eating disorders are anorexia nervosa, bulimia nervosa and binge-eating disorder. Eating disorders can cause serious physical problems and, at their most severe, can even be life-threatening. Most people with eating disorders are females, but males can also have eating disorders. An exception is binge-eating disorder, which appears to affect almost as many males as females. Treatments for eating disorders usually involve psychotherapy, nutrition education, family counseling, medications and hospitalization.
Anorexia nervosa is a very serious illness that has a wide range of effects on the body and mind. It is also associated with other problems, ranging from frequent infections and general poor health to life-threatening conditions. Some researchers believe that it should not be approached as a simple eating disorder but as a serious condition requiring staging according to severity.
At this time, no treatment program for anorexia nervosa is completely effective. Recovery rates vary between 23 – 50%, and relapses range from 4 – 27%. Recovery takes an average of 5 – 6 years from the time of diagnosis. Up to 30% of patients do not recover. Even after treatment and weight gain, many patients continue to display characteristics of the disorder, including perfectionism and a drive for thinness, which could keep them at risk for recurrence.
Eating disorders are diagnosed based on signs, symptoms and eating habits. When doctors suspect someone has an eating disorder, they typically run many tests or perform exams. These can help pinpoint a diagnosis and also check for related complications. You may see both a medical doctor and a mental health provider for a diagnosis.
The first step towards a diagnosis is to admit the existence of an eating disorder. Often, the patient needs to be compelled by a parent or others to see a doctor because the patient may deny and resist the problem. Some patients may even self-diagnose their condition as an allergy to carbohydrates, because after being on a restricted diet, eating carbohydrates can produce gastrointestinal problems, dizziness, weakness, and palpitations. This may lead such people to restrict carbohydrates even more severely.
It is often extremely difficult for parents as well as the patient to admit that a problem is present. For example, because food is such an intrinsic part of the mother-child relationship, a child’s eating disorder might seem like a terrible parental failure. Parents may have their own emotional issues with weight gain and loss and perceive no problem with having a “thin” child.
- Physical evaluations These exams and tests generally include: Physical exam. This may include measuring height, weight and body mass index; checking vital signs, such as heart rate, blood pressure and temperature; checking the skin for dryness or other problems; listening to the heart and lungs; and examining your abdomen. Laboratory tests. These may include a complete blood count, as well as more-specialized blood tests to check electrolytes and protein, as well as liver, kidney and thyroid function. A urinalysis also may be done. Other studies. X-rays may be taken to check for pneumonia or heart problems. Electrocardiograms may be done to look for heart irregularities. You may also have a bone density test.
- Psychological evaluations In addition to a physical exam, you’ll have a thorough psychological evaluation. Your doctor or mental health provider may ask you a number of questions about your eating habits, beliefs and behavior. The questions may focus on your history of dieting, bingeing, purging and exercise. You’ll explore how you perceive your body image and how you think others perceive your body image. You may also fill out psychological self-assessments and questionnaires.
- Diagnostic criteria To be diagnosed with an eating disorder, you must meet criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association. Each eating disorder has its own set of diagnostic criteria. Your mental health provider will review your signs and symptoms to see if you meet the necessary diagnostic criteria for a particular eating disorder. Some people may not meet all of the criteria but still have an eating disorder and need professional help to overcome or manage it.
The first step in diagnosis is admitting that you have symptoms of an eating disorder. You may need support and encouragement from others before seeking help.
- Initial evaluation-During the initial evaluation, your doctor will ask about your symptoms and medical history, the amount of food you eat, and how you try to control your weight.
- Physical exam and tests-Your doctor will give you a physical exam and check your height and weight. If you have symptoms of Bulimia Nervosa , she may look at your teeth to check for erosion (a sign of frequent vomiting). You will also have routine blood, urine, and other tests to check your overall health status.
- Psychiatric evaluation-A mental health professional may perform a series of tests and evaluate you for other psychiatric conditions, such as Depression and Anxiety , which are common in people with eating disorders. Diagnosis of a particular type of eating disorder is based on an evaluation of your symptoms using the criteria of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Screening tests such as the Eating Attitudes Test (EAT-26) can be used to screen for symptoms of eating disorders.
Diagnosis of Anorexia Nervosa
According to the DSM-IV, Anorexiais characterized by:
- An intense fear of gaining weight
- A refusal to maintain adequate nutrition, often associated with an erroneous image of the self as fat
- Loss of original body weight to 85% or less of what is expected for normal height and weight
- Disturbance of body image and negative self-evaluation
- Absence of at least three consecutive menstrual periods in females who have started menstruating
Diagnosis of Bulimia Nervosa
According to the DSM-IV, bulimia nervosa is characterized by:
- Frequent occurrence of binge eating episodes accompanied by a sense of loss of control
- Recurrent inappropriate behavior (ie, vomiting, use of laxatives, fasting, or excessive exercise) intended to prevent weight gain
- Both of the above behaviors occur at least twice a week, on average, for three months
- Negative self-evaluation influenced by body shape and weight
Diagnosis of Binge Eating Disorder
Binge eating disorder is characterized by:
- Binge eating episodes accompanied by a sense of loss of control
- No inappropriate behavior to prevent weight gain
- The behavior occurs at least twice a week, on average, for three months
Eating Attitudes Test
This is a screening measure to help you determine whether you might have an eating disorder that needs professional attention. This screening measure is not designed to make a diagnosis of an eating disorder or take the place of a professional diagnosis or consultation. Please take the time to fill out the below form as accurately, honestly and completely as possible. All of your responses are confidential.
|I am terrified about being overweight.|
|I avoid eating when I am hungry.|
|I find myself preoccupied with food.|
|I have gone on eating binges where I feel that I may not be able to stop.|
|I cut my food into small pieces.|
|I am aware of the calorie content of foods that I eat.|
|I particularly avoid food with a high carbohydrate content (i.e. bread, rice, potatoes, etc.)|
|I feel that others would prefer if I ate more.|
|I vomit after I have eaten.|
|I feel extremely guilty after eating.|
|I am preoccupied with a desire to be thinner.|
|I think about burning up calories when I exercise.|
|Other people think that I am too thin.|
|I am preoccupied with the thought of having fat on my body.|
|I take longer than others to eat my meals.|
|I avoid foods with sugar in them.|
|I eat diet foods.|
|I feel that food controls my life.|
|I display self-control around food.|
|I feel that others pressure me to eat.|
|I give too much time and thought to food.|
|I feel uncomfortable after eating sweets.|
|I engage in dieting behavior.|
|I like my stomach to be empty.|
|I have the impulse to vomit after meals.|
|I enjoy trying rich new foods.|
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