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Eating Disorders Assessment & Diagnosis SW 593 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. 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. 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. 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 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. 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 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 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. 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. 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. 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. Assessment Often these behaviors are accompanied with the following: – Depression – Low self-esteem – Distorted body image – Hopelessness – Anxiety – Suicidal tendencies 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 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. 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 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.
