Eating Disorders
A discussion on the appropriate assessment, diagnosis & treatment of eating d/o’s + a relevant patient scenario.
DISCLAIMER
The content provided in this Substack post is for entertainment and informational purposes only and is not intended to serve as medical advice. The views and opinions expressed herein are those of the writer and should not be taken as definitive or authoritative. Readers should not rely solely on the information provided in this post to make decisions about patient care. Instead, use this content as a starting point for further research and consult a qualified healthcare professional before making any changes to treatment or medication regimens.
Today’s post will focus on eating disorders. It will be broken into three parts: assessment, diagnosis & treatment. It should go without saying, but each eating disorder is different and unique, so we will really just be scratching the surface for each. Enjoy!
Assessment of Eating Disorders
Eating disorders are complex mental health conditions that affect individuals of all ages, genders, and backgrounds. They can have serious physical and psychological consequences if left untreated. Therefore, early and accurate assessment is critical for effective treatment.
Assessment of eating disorders involves a comprehensive evaluation of an individual's medical, psychiatric, and nutritional status. It typically involves a range of techniques, including clinical interviews, self-report questionnaires, and physical exams.
Clinical Interviews:
Clinical interviews are a critical component of the assessment process. They involve a face-to-face discussion between the healthcare provider and the individual, where the provider gathers information about the individual's medical history, eating behaviors, and psychological symptoms.
The healthcare provider should use a non-judgmental and empathetic approach to help the individual feel comfortable and open about their experiences. They should also use standardized interview questions to ensure that they cover all the relevant topics.
Self-Report Questionnaires:
Self-report questionnaires are useful in gathering information about the individual's eating behaviors, attitudes, and beliefs. There are several validated questionnaires that healthcare providers can use to assess eating disorders, including the Eating Disorder Examination Questionnaire (EDE-Q) and the Eating Attitudes Test (EAT).
These questionnaires can provide valuable insights into the individual's eating patterns and attitudes, as well as the severity of their symptoms.
Physical Exam:
A physical exam is essential to assess the individual's overall health and identify any physical complications related to their eating disorder. This can include measuring vital signs, checking for signs of malnutrition, and evaluating the individual's oral health.
The healthcare provider should also assess the individual's body mass index (BMI) to determine if they are underweight, normal weight, or overweight.
Diagnosis of Eating Disorders
The diagnosis of eating disorders is based on criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The DSM-5 provides specific diagnostic criteria for three main types of eating disorders:
Anorexia Nervosa:
Anorexia nervosa is characterized by a significantly low body weight, an intense fear of gaining weight or becoming fat, and a distorted body image. To meet the diagnostic criteria for anorexia nervosa, an individual must exhibit these symptoms and restrict their food intake.
Bulimia Nervosa:
Bulimia nervosa is characterized by recurrent episodes of binge eating followed by compensatory behaviors, such as self-induced vomiting, laxative use, or excessive exercise. To meet the diagnostic criteria for bulimia nervosa, an individual must exhibit these symptoms on average at least once a week for three months.
Binge Eating Disorder:
Binge eating disorder is characterized by recurrent episodes of binge eating without compensatory behaviors. To meet the diagnostic criteria for binge eating disorder, an individual must exhibit these symptoms on average at least once a week for three months.
Other Specified Feeding or Eating Disorders (OSFED):
OSFED is a category for individuals who have disordered eating patterns that do not meet the full criteria for anorexia nervosa, bulimia nervosa, or binge eating disorder.
To make an accurate diagnosis, healthcare providers should use a combination of clinical interviews, self-report questionnaires, and physical exams, in addition to considering the DSM-5 criteria.
Treatment of Eating Disorders
The treatment of eating disorders typically involves a multidisciplinary approach that addresses the physical, psychological, and nutritional needs of the individual. The primary goals of treatment are to restore physical health, improve psychological functioning, and prevent relapse.
There are several evidence-based treatments available for eating disorders, including:
Cognitive-Behavioral Therapy (CBT):
CBT is a form of psychotherapy that helps individuals with eating disorders identify and change negative thoughts and behaviors related to food, weight, and body image. CBT can be delivered individually or in a group setting.
Family-Based Therapy (FBT):
FBT is a type of therapy that involves the family in the treatment process. FBT can be particularly effective for adolescents with anorexia nervosa and involves parents in refeeding their child and providing support throughout the recovery process.
Interpersonal Psychotherapy (IPT):
IPT is a form of psychotherapy that focuses on improving interpersonal relationships and communication skills. IPT can be helpful for individuals with bulimia nervosa and binge eating disorder who struggle with emotional regulation and interpersonal conflicts.
Nutritional Counseling:
Nutritional counseling is an essential component of the treatment of eating disorders. Registered dietitians can help individuals with eating disorders develop healthy eating habits, meal planning strategies, and improve their relationship with food.
Medications:
Medications may be helpful in the treatment of eating disorders, but they should be used in combination with psychotherapy and nutritional counseling. Selective serotonin reuptake inhibitors (SSRIs) have been shown to be effective in treating bulimia nervosa and binge eating disorder.
In the scenario look for how the PMHNP uses the principles discussed in the earlier sections in order to appropriately treat this patient:
Samantha is a 23-year-old college student who has been struggling with an eating disorder for several years. She has lost a significant amount of weight and is experiencing physical complications related to her disordered eating patterns. She has been avoiding social situations that involve food and has become increasingly isolated. Samantha's primary care physician referred her to a PMHNP who specializes in eating disorders.
Assessment:
During the initial assessment, the PMHNP conducted a clinical interview with Samantha and gathered information about her medical, psychiatric, and nutritional history. The PMHNP used standardized questions to ensure that she covered all relevant topics and also used the Eating Disorder Examination Questionnaire (EDE-Q) to gather information about Samantha's eating behaviors, attitudes,
Keep reading with a 7-day free trial
Subscribe to Short Bits for Inquisitive PMHNP's to keep reading this post and get 7 days of free access to the full post archives.