Diagnosis & AssessmentEating Disorders

Criteria

Complexity

Issues

Core Concept of Diagnostic Group

• Obsessive concern about becoming overweight or fat

• Distorted body image

• Inability to appropriately control food intake to maintain healthy body weight

• Fluctuation of self-evaluation dependent on perceived body shape or weight

Criteria Applicable to Multiple Disorders

• One criterion– common to both Anorexia Nervosa &

Bulimia Nervosa

• Individual’s self-evaluation is unduly influenced by his/her body weight or shape

Necessary Clinical Information

• Current & past weight• Current & past patterns of

eating • Current & past feelings about

food• Unusual eating rituals• Current & past appetite• History of dieting• Current & past feelings about

weight• Medical Illnesses

• Current meds & abused substances

• Psychiatric illnesses • Psychiatric symptoms (mania,

anxiety, etc• Episodes of binge eating• Psychological conflicts related

to self-evaluation (i.e., self-esteem)

• Relationship between weight & patient’s self-esteem

• Family history of eating disorders

Making a Diagnosis

• Characterized by– ever-changing interaction between amount of

food consumed– individuals’ perception of weight or shape– & relationship of perception to self-esteem

Questions for Diagnosis

• Does individual body weight or shape have undue influence on self-evaluation & does individual fear gaining weight

• Does individual refuse to maintain body weight above a minimum (e.g., 85%) of expected normal weight for age & height?

More Questions

• Does individual binge eat?

• Does an individual have an eating disturbance that doesn’t meet the criteria for a specific eating disorder?– Problem is sometimes one of interpretation

rather than total absence of criteria

Precedence of a Diagnosis

• Presence of any nonpsychiatric medical disorder causing weight loss takes precedence over AN

• Diagnosis of Anorexia precedence over Bulimia Nervosa

• If individual with Schizophrenia has serious weight loss & meets AN criteria– both diagnosis given

• Individual with Borderline Personality Disorder who binges meets criteria for Bulimia Nervosa– both diagnoses given

Necessity of Comprehensive, Multidimensional Assessment

• Many new self-report measures

• Revisions of established instruments

Relevance of Assessment

• Assessment as a process– May occur over several sessions

• Assessment serves multiple services– Diagnosis– Information for treatment planning

• Assessment of severity & associated symptomatology necessary to treatment planning– Heterogeneity in eating-related symptoms– Comorbid pathology

• Assessment as multimodal

Multimodal Nature of Assessment

• Information from interviews

• Carefully selected battery of self-report instruments/questionnaires

• Self-monitoring data– Diaries– 3x5 cards

Interview: Making Diagnosis

• Clinical Concepts – Obsessive concern about becoming

overweight or fat– Distorted body image– Inability to appropriately control food intake

to maintain a healthy body weight– Fluctuation of self-evaluation dependent on

perceived body shape or weight

Interview: Weight & Body Image

• Current weight & height – with weight history– highest & lowest weights since attaining current height– Frequency of weight fluctuations– Perceptions of weight early in life– Consideration of client’s ideal weight

• Significant life events & relation to weight fluctuations– Emerging patterns

• Insight of client

Interview: Body Image Disturbance

• Disturbance in perception– Body image distortion

• Selected body parts as unrealistically large

• Disturbance in cognition & affect– Body image dissatisfaction

• Appearance evaluated negatively

• Disturbance in behavior– Body checking

– Avoiding anxiety provoking situations

Interview: Ideal Weight

• Questions about “feeling fat”• Meaning attached to attaining/maintaining

ideal weight• Impact weight gain/loss on thoughts &

feelings about self• Others’ perceptions of her weight & shape• Degree of avoidance/restriction in

activities involving body exposure

Interview: Abnormal Eating Behaviors

• Binge Eating– Context within which the eating occurs– Onset– Frequency– Severity

• Topographical information – Description of daily eating patterns

• Typical meal• Typical binge• Avoided foods; foods causing distress

– Timing of binges– Antecedents & consequences

Interview: Weight Control Measures

• History of dieting– Triggered by episodes of bingeing– Frequent weighing– Onset, frequency, & preferred methods of diet

• Emphasize most recent period of dieting– To assess connection to stressors– Compensatory methods – close-ended questions more

successful– Specific terms as

• self-induced vomiting, laxatives, diuretics, enemas, appetite suppressants, other meds, fasting, excessive exercise

Self-Report Questionnaires

• Multiple uses• Expand assessment process• Screening instruments for symptomalogy

& severity• Inform treatment planning by identifying

& clarifying issues requiring emphasis• Incorporate other general psychological

distressors

Self-Report: Body Image Disturbance

• Delineate components of body image disturbance to target– Body size distortion: Correction of size & weight

overestimation• Techniques for estimating body part size• Distorting-image techniques

– Body image dissatisfaction: modify negative & distorted thinking

• Body Cathexis scale & Eating Disorders Inventory-2 body dissatisfaction subscale

– Body image avoidance: incorporating exposure to situations

• Body Image Avoidance Questionnaire

Self-report: Maladaptive Eating Attitudes, Behaviors, & Cognitions

• Measures of treatment progress & outcome– Eating Attitudes Test (EAT)

– EDI-2

– BULIT-R

– Forbidden Food Survey

– Bulimic Thoughts Questionnaire (BTQ)

– Mizes Anorectic Cognitions (MAC) questionnaire

– Bulimic Cognitive Distortions Scale

Self-Report:Assessment of General Psychopathology

• Self-Report

• Prior or simultaneous intervention

• Minnesota Multiphasic Personality Inventory-2 (MMPI-2)

• Personality Diagnostic Questionnaire—Revised (PDQ-R)

• Symptom Checklist 90

Self-Monitoring: Naturalistic Assessment

• Eating Diaries – self-developed or published– Detailed information about eating behavior– Focal point of intervention

• Clarify relationship between events & binge episodes• Awareness of internal states to eating/restriction of eating

– Examine treatment progress & outcome

• Topographical information– Frequency, timing, meals, snacks, binge episodes– Compensatory weight control methods– Types & quantities of food consumed– Information about location, persons present, affect & thoughts, – Nutritional composition