Who diagnoses eating disorders?
Eating disorders can be diagnosed by a number of professionals, includin medical physicians or mental health professionals, such as psychiatrists, psychologists, or social workers. Sometimes a pediatrician or family practice doctor will diagnose an eating disorder after noticing symptoms within the course of a regular check-up or having questions brought up by the patient or his/her parent. On other occasions, a patient or his/her family will have concerns and schedule an assessment with a mental health professional.
Is there a test for eating disorders?
While eating disorders are serious illnesses with physical complications, there is no laboratory test to screen for eating disorders. However, there are multiple questionnaires and assessment tools that may be used to assess a person's symptoms. These may include self-report instruments, such as the Eating Disorder Inventory, the SCOFF Questionnaire, or the Eating Attitudes Test.
An eating disorder professional may also simply interview the person about their experience. Questions will typically include topics such as current eating and exercise habits, how much a person weighs, and whether they have recently lost weight, as well as the person's views on weight and body image. A professional may also ask about physical symptoms, such as being cold much of the time or bruising easily.
Within the course of a physical, a physician may also use a number of diagnostic tools, including -- but not limited to -- blood work, a bone density exam, and/or an electrocardiogram (EKG), to assess whether there are any complications from the eating disorder.
What criteria are used to diagnose eating disorders? Where do these criteria come from?
Physicians and mental health professionals use diagnostic criteria from the Diagnostic & Statistical Manual of Mental Disorders, 4th Ed. Text Revision (DSM-IV-TR), to diagnose anorexia nervosa, bulimia nervosa and binge eating disorder. People who are struggling with some of the symptoms of an eating disorder but do not meet full criteria or who are struggling with issues surrounding weight and food to the point that it is an issue in their life may also be diagnosed with "eating disorder, not otherwise specified."
Criteria for anorexia nervosa include symptoms related to weight, a fear of weight gain, body image issues, and amenorrhea (absence of a menstrual cycle) in women who have reached puberty.
Criteria for bulimia nervosa include recurrent binge eating and purging behaviors occurring at least twice per week for at least three months, as well as a self-evaluation that is based on weight and/or body shape.
The DSM-IV-TR is a manual published by the American Psychiatric Association. It is currently in its fourth edition. Each diagnostic category in the book has been created based on research and feedback from clinicians. The fifth edition is expected to be published in 2013.
What happens after diagnosis?
A treatment team and treatment plan will be formulated based on the needs of the patient. This may include referral to other professionals and/or more in-depth assessment of symptoms. A treatment team will typically include a therapist, a dietician, and a physician or psychiatrist. Typically, the professional who diagnoses the eating disorder can help refer a person to other eating disorder professionals within the community. A treatment plan may include outpatient treatment, inpatient treatment, or residential treatment.
Rosen, D.S. and the Committee on Adolescence (2010). Clinical report: Identification and management of eating disorders in children and adolescents. Pediatrics, 126(6), 1240-1253.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., Text Revision). Washington, DC: Author.
Costin, C. (2007). The eating disorder sourcebook (3rd Ed.). New York, NY: McGraw Hill.