Diagnosing eating disorders

Diagnosing an eating disorder usually involves a measurement of height and weight, and then some basic questions: how much do you eat? Do you binge? Do you purge? How much you exercise? Do you think you're fat? If you're seeing a therapist, you may have to fill out a questionnaire, like the EAT-26. If you're seeing a doctor who is decent, they may check your bloodwork and if you're really lucky, do an EKG.

The problem is that this doesn't always catch everything. Why? The DSM-IV isn't foolproof. It's more of a description than a diagnosis, made more for people in their late teens and into adulthood than for younger sufferers, and even some older ones. Many young children with EDs may not express a phobia of fatness, and this is causing many GPs to miss the diagnosis. Nor do people from non-Western cultures always express a weight/fat phobia, although this phobia is slowly increasing. Furthermore, the amenorrhea criteria for diagnosing anorexia has become increasingly controversial, and recent research suggests that we scrap the criteria entirely.

Moreso the questions about how much you eat and how you feel about your body may not always elicit the most honest of answers. Many sufferers (myself included) think they eat just freaking fine, dammit even when their calories are less than 1/4 what is recommended for healthy women. And even when sufferers do realize that their eating habits and body weight give them an eating disorder diagnosis, many don't want help or are deeply ashamed of their abnormal behaviors. Eating disorders do not lend themselves well to honesty. A brand new study is looking at what particular feelings and emotions help distinguish between women with EDs and women without them.

So when I see research about diagnostic brain scans for PTSD and depression, I get excited. Although these brain scans are still a long way off from being used in eating disorders, there is an increasing discussion about their potential use in research and diagnosis. These scans can bring a level of objectivity to the diagnosis. They let both treatment providers and sufferers see what's going on. They might relieve the sufferers of the compulsion to lie about ED's torment.

With the growing awareness of PTSD in the military, some psychiatrists are beginning to wonder at how well current criteria for PTSD are capturing the actual cases of PTSD in the military. Do the current standards exclude too many sufferers? Or could they be too inclusive, lumping people with sub-clinical symptoms into a full PTSD diagnosis that becomes a self-fulfilling prophecy?

I wonder the same about eating disorders. So many times, the media speaks of an "epidemic," yet we don't have the cold hard numbers to indicate this. Certainly, EDs are being diagnosed more frequently in younger children, in men, in minorities. But we don't yet know whether they were there to begin with and we just missed them.

There is so much we don't know about eating disorders, and a good place to start would be better, more comprehensive diagnostics.


Cammy said...

Last month's Scientific American has a good article about the over-diagnosis of PTSD. The author is careful not to claim PTSD isn't a valid illness, but it points out how easy it is to lump people with other conditions (schizophrenia, depression, etc, or people who are just in the natural coping process) into that one category. So not only are you tagged with a label, it's the wrong one, and you're not getting the treatment for the real condition. It's a good article, makes points I never thought of before. Mental illnesses involve so many shades of gray, it's very hard to pin people's psyches into absolute discrete categories.

Carrie Arnold said...


You caught my mistake! I meant to link to the SciAm article in the text but I forgot.

Will go make that change now- thanks!

Kim said...

I agree -- too many physicians are tied to the DSM, and it's not always accurate. When my eating disorder began, I didn't express a fear of being fat (mostly because I knew that was insane since I was on the thin side before my ED). There are still so many misconceptions about EDs. Medical teams focus on weight, but it's much more than that. There are times I've had my period, but still been way into my eating disorder. There are a few out there who understand the real mechanics, but most are content with the labels.

Ai Lu said...

Of the questions that the authors of the ED/Feelings study asked, it was interesting to learn that:

"Questions relating to weight and shape for self-esteem ('feeling fat', 'fearing weight gain' and 'wanting to lose weight') discriminated poorly" between women with ED and women without.

Perhaps that is because fear of gaining weight is now so ubiquitous among women that it does not adequately distinguish between ED-folks and the rest?

Carrie Arnold said...

Ai Lu,

I'm going to guess yes, that's right. Sad.

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I'm a science writer, a jewelry design artist, a bookworm, a complete geek, and mom to a wonderful kitty. I am also recovering from a decade-plus battle with anorexia nervosa. I believe that complete recovery is possible, and that the first step along that path is full nutrition.

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