1. Eating Disorders Assessment & Diagnosis SW 593

2. 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.

3. 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.

4. 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.

5. 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

6. 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.

7. 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

8. 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

9. 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.

10. 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.

11. 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.

12. 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.

13. Assessment  Often these behaviors are accompanied with the following: –Depression –Low self-esteem –Distorted body image –Hopelessness –Anxiety –Suicidal tendencies

14. 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

15. 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.

16. 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

17. 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.