Eating Disorders: Diagnosis and Treatment

Diagnosis

A medical and psychiatric history and physical examination is necessary, with the diagnosis based on criteria developed by The American Psychiatric Association.

The American Psychiatric Association's diagnostic criteria for anorexia nervosa are summarized as follows:

• Refusal to maintain body weight at or above a minimally normal weight for age and height (e.g., weight loss leading to maintenance of body weight less than 85 percent of that expected; or failure to make expected weight gain during period of growth, leading to body weight less than 85 percent of expected).
• Intense fear of gaining weight or becoming fat, despite being significantly underweight.
• Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of current low body weight.
• The absence of at least three consecutive menstrual cycles (prior to menopause).

The diagnostic criteria for bulimia nervosa are summarized as follows:

• Recurrent episodes of binge eating during discrete periods of time (e.g., within any two-hour period), characterized by eating an amount of food that is definitely larger than most people would eat during a similar period of time, and a sense of lack of control over eating during the episode.
• Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise.
• Episodes of binge eating and inappropriate compensatory behaviors occurring, on average, at least twice a week for three months.
  

Screening questionnaires are available. For example, answers of "yes" to two or more of the questions below strongly suggest an eating disorder:

1. Do you make yourself sick because you feel uncomfortably full?
2. Do you worry you have lost control over how much you eat?
3. Have you recently lost more than 14 pounds in a three-month period?
4. Do you believe yourself to be fat when others say you are too thin?
5. Would you say that food dominates your life?

Lab testing may include blood tests, EKG, pregnancy testing, bone-density testing, or MRI of the brain.

Treatment

• Psychiatric therapy is the treatment of choice. This may include cognitive-behavioral therapy, family-based therapy, and group therapy. Also, self-help manuals appear to be effective in reducing binge eating, and programs such as Overeaters Anonymous are often effective as well.
• Fluoxetine (Prozac) was recently approved for treatment of Bulimia by the Food and Drug Administration. It appears to be effective in about 60 percent of cases. Further, combining medication with psychiatric therapy appears to work better than either treatment alone.
• In severe cases, hospitalization and medical therapy may be necessary for refeeding and to treat electrolyte disturbances, dehydration, heart arrhythmias, and other complications.
• Vitamin and mineral supplementation may be necessary.
• A structured eating program may help restore healthy eating habits.