Eating Disorders: Anorexia and Bulimia

Description

Alternative Names

Diagnosis

The first step towards a diagnosis is to admit the existence of an eating disorder. Often, the patient needs to be compelled by a parent or others to see a doctor because the patient may deny and resist the problem. Some patients may even self-diagnose their condition as an allergy to carbohydrates, because after being on a restricted diet, eating carbohydrates can produce gastrointestinal problems, dizziness, weakness, and palpitations. This may lead such people to restrict carbohydrates even more severely.

It is often extremely difficult for parents as well as the patient to admit that a problem is present. For example, because food is such an intrinsic part of the mother/child relationship, a child's eating disorder might seem like a terrible parental failure. Parents may have their own emotional issues with weight gain and loss and perceive no problem with having a "thin" child.

Interview Tests

It is recommended that a supportive companion be present during part of the initial medical interview to offer additional information on the patient's eating history and to help offset any resistance or denial the patient may express.

Various questionnaires are available for assessing patients. Of note is a brief British test called the SCOFF questionnaire. It is proving to be very reliable in accurately identifying both very young and adult patients who meet the full criteria for anorexia or bulimia nervosa. (It may not be as accurate in people who do not meet the full criteria.)

Diagnosing Bulimia Nervosa

In spite of the prevalence of bulimia, in one study only 30% of Midwest family physicians had ever diagnosed bulimia in a patient. Younger and female physicians are more likely to detect bulimia. A physician should make a diagnosis of bulimia if there are at least two bulimic episodes per week for three months. Because people with bulimia tend to have complications with their teeth and gums, dentists could play a crucial role in identifying and diagnosing bulimia.

Diagnosing Anorexia Nervosa

Generally, an observation of physical symptoms and a personal history will quickly confirm the diagnosis of anorexia. The standard criteria for diagnosing anorexia nervosa are:

• The patient's refusal to maintain a body weight normal for age and height.
• Intense fear of becoming fat even though underweight.
• A distorted self-image that results in diminished self-confidence.
• Denial of the seriousness of emaciation and starvation.
• The loss of menstrual function for at least three months.

The physician then categorizes the anorexia further:

• Restricting (severe dieting only).
• Anorexia bulimia (binge-purge behavior).

Because the disorder rarely shows up in men, physicians may not be on the lookout for it in male patients, even if they show classic symptoms of anorexia. Physicians should be very aware of these symptoms in anyone, particularly in athletes and dancers.

Diagnosing Complications of Eating Disorders

Once a diagnosis is made, physicians should immediately check for any serious complications of starvation. They should also rule out other medical disorders that might be causing the anorexia. Tests should include the following:

• A complete blood count.
• Tests for electrolyte imbalances. Low potassium levels indicate that the disorder is more likely to be accompanied by the binge-purge syndrome.
• Test for protein levels.
• An electrocardiogram and a chest x-ray.
• Tests for liver, kidney, and thyroid problems.
• A bone density test.