Psychiatric Assessment

The psychiatric assessment must include particular attention to symptoms of restricting, purging, binge eating, and exercising, as well as feelings about shape and weight. Anxiety and compulsive behavior around food and weight require investigation. The presence of depressed mood, anhedonia, insomnia, decreased energy, and flattened affect must be explored given their associations with malnutrition (Franklin et al. 1948; Keys et al. 1950). Noting the time of onset of depression symptoms relative to disordered eating symptoms is important to help differentiate a primary depressive disorder from an eating disorder.

Because patients frequently minimize or deny their symptoms, the consultant needs to obtain in formation from the family as well as the patient. Caretakers should be questioned about the patient's eating behavior and about any adverse or distorted comments about weight or body that the patient may have made in the past. The types of food the patient avoids can be a useful clue; those who avoid high-calorie or high-fat foods are more likely to have an eating disorder. Although the diagnosis of an eating disorder cannot always be definitively ruled in or out based on a single evaluation, direct observation of the patient's eating behavior over the course of an inpatient medical admission or during outpatient treatment will generally clarify the diagnosis.

Multiple standardized assessment instruments for eating disorders are available. They include the Eating Disorder Examination (Z. Cooper and Fair-burn 1987), Eating Disorder Inventory-2 (Garner 1991), and Eating Attitudes Test (Garner and Garfield 1979; Garner et al. 1982).

Breaking Bulimia

Breaking Bulimia

We have all been there: turning to the refrigerator if feeling lonely or bored or indulging in seconds or thirds if strained. But if you suffer from bulimia, the from time to time urge to overeat is more like an obsession.

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