Eating Disorders Assessment & Diagnosis SW 593
Introduction • Eating disorders often originate in childhood or adolescence • Approximately 5 to 10 million Americans suffer from some form of eating disorder. • Anorexia Nervosa is the third most common chronic illness in adolescent women. • Since 1960, eating disorders has increased threefold in young adult women.
Introduction • 50% of females between the ages of 11 and 13 see themselves as overweight. • 80% have attempted to lose weight. • 10% have reported self-induced vomiting. • The death rate for individuals with anorexia nervosa has been 5.6% per decade.
Anorexia Nervosa • Characterized by significant weight loss resulting from excessive dieting. • The body weight is less than 85% of the ideal for their height and age. • Also have an unreasonable fear of becoming fat regardless of their low body weight. • It is often accompanied by a distorted body image.
Anorexia Nervosa • There has been a cessation of menstrual periods for at least three consecutive cycles. • Two subtypes: • Restricting Type • Severely restricting food intake • Binge/Purging Type • Food restricting plus binge eating and purging behaviors
Bulimia Nervosa • Generally maintain a normal body weight for their age and height. • Pattern of binge eating that occurs at least two times a week over a 3 month period. • A binge consists of a large amount of food consumed in a relatively short period of time. • The individual feels a lack of control over the eating.
Bulimia Nervosa • Will also engage in the following activities to prevent weight gain: • Vomiting • Laxative, diuretic, or enema abuse • Fasting • Excessive exercise • Two subtypes: • Purging Type • Non-purging Type
Assessment • It is important to conduct a thorough psychosocial evaluation, including: • Demographic information • Reason for visit • Support systems • Family information • Medical history • Other history of mental health intervention
Assessment • Note the client’s presentation including: • Baggy clothing • Sallow complexion • Dark circle under eyes • Bite marks on the hands, fingers, or nails • Excessive fine body-hair growth • Deteriorated teeth and gums • Unhealthy head of hair • Unusually thin limbs or bony facial appearance.
Assessment • Clients who present with an eating disorder may not be initially comfortable discussing behaviors: • Stigma • Shame • Fear of being discovered • The behaviors have been held secret for a significant period of time.
Assessment • Pressure from family/friends to change behavior before they are ready to do so. • Family members may even maintain or support denial of the problem due to a generational pattern. • Client and family may even question the validity of the diagnosis. • Many adolescents are pressured into therapy by family, counselors, friends/relatives.
Assessment • Development of a therapeutic relationship becomes absolutely essential. • Assessment should include: • Obtaining a history of dieting/compulsive eating habits. • Presence of specific eating-disordered patterns.
Assessment • Often these behaviors are accompanied with the following: • Depression • Low self-esteem • Distorted body image • Hopelessness • Anxiety • Suicidal tendencies
Assessment • Rule out other possible mental disorders: • Substance abuse • Major depression • Body Dysmorphic Disorder • Obsessive-Compulsive Disorder • Rule out possible Personality Disorders: • Borderline • Dependent • Histrionic • Avoidant
Assessment • Presence of rigid, fixed thought patterns resulting in problems with: • Social relationships • Interpersonal skills • Ability to maintain intimate connections with other people • If under 18, family situation should be thoroughly assessed.
Assessment • Family factors: • Enmeshed • Blurred boundaries • Lack of separation and individuation • Chaotic family dynamics (bulimia) • Power imbalances • Lack of flexibility • Lack of clear family structure
Assessment • It is essential that client’s case be followed by a medical doctor. • Hospitalization may be necessary. • Written contracts are helpful. • Written consents are required to exchange information with the physician. • Two of the most lethal disorders in the DSM.