Eating disorders
Description
An in-depth report on the treatment and prevention of eating disorders.
Alternative Names
Anorexia; Bulimia; Binge eating
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.
Interview Tests
It is recommended that a supportive companion be present during part of the initial medical interview to offer additional information on the patient's eating history and to help offset any resistance or denial the patient may express.
Various questionnaires are available for assessing patients. The Eating Disorders Examination (EDE), which is an interview of the patient by the doctor, and the self-reported Eating Disorders Examination-Questionnaire (EDE-Q) are both considered valid tests for assessing eating disorder diagnosis and determining specific features of the individual’s condition (such as vomiting or laxative use).
Another test is called the SCOFF questionnaire. It is proving to be very reliable in accurately identifying both very young and adult patients who meet the full criteria for anorexia or bulimia nervosa. (It may not be as accurate in people who do not meet the full criteria.)
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SCOFF Questionnaire
Do you make yourself
Sick
because you feel uncomfortably full?
Do you worry you have lost
Control
over how much you eat?
Have you recently lost more than
One
stone 's worth of weight (14 pounds) in a 3-month period?
Do you believe yourself to be
Fat
when others say you are too thin?
Would you say that
Food
dominates your life?
Answering yes to two of these questions is a strong indicator of an eating disorder. |
Diagnosing Bulimia Nervosa
In spite of the prevalence of bulimia, in one study only 30% of Midwest family doctors had ever diagnosed bulimia in a patient. Younger and female doctors are more likely to detect bulimia. A doctor should make a diagnosis of bulimia if there are at least two bulimic episodes per week for 3 months. Because people with bulimia tend to have complications with their teeth and gums, dentists could play a crucial role in identifying and diagnosing bulimia.
Diagnosing Anorexia Nervosa
Generally, an observation of physical symptoms and a personal history will quickly confirm the diagnosis of anorexia. The standard criteria for diagnosing anorexia nervosa are:
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The patient's refusal to maintain a body weight normal for age and height
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Intense fear of becoming fat even though underweight
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A distorted self-image that results in diminished self-confidence
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Denial of the seriousness of emaciation and starvation
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The loss of menstrual function for at least 3 months
The doctor then categorizes the anorexia further:
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Restricting (severe dieting only)
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Anorexia bulimia (binge-purge behavior)
Because the disorder rarely shows up in men, doctors may not be on the lookout for it in male patients, even if they show classic symptoms of anorexia. Doctors should be very aware of these symptoms in anyone, particularly in athletes and dancers.
Diagnosing Complications of Eating Disorders
Once a diagnosis is made, doctors should immediately check for any serious complications of starvation. They should also rule out other medical disorders that might be causing the anorexia. Tests should include:
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A complete blood count
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Tests for electrolyte imbalances (low potassium levels mean the disorder is more likely to be accompanied by the binge-purge syndrome)
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Test for protein levels
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An electrocardiogram and a chest x-ray
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Tests for liver, kidney, and thyroid problems
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A bone density test
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Review Date: 12/13/2006
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Reviewed By: Harvey Simon, MD, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital.
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