Increased Awareness of Eating Disorders has Changed the Process of an Initial Assessment

The last post reviewed elements of a thorough assessment for someone with an eating disorder. There are key pieces to this initial consultation that are necessary to create an appropriate treatment plan.

The first issue is that eating disorders are not a homogeneous set of illnesses. Underlying connected, and sometimes causal, conditions need attention as well. The increased awareness of eating disorders means many people are diagnosed without giving attention to other concerns. It’s easy to just decide the primary issue is an eating disorder without considering many more possibilities as well.

As a result, these days I am more likely to see someone diagnosed with an eating disorder whose main diagnosis is depression. In the past the opposite was much more likely to be true. The takeaway message is that diagnosing someone with an eating disorder without considering all other psychiatric issues is inadvisable and often counterproductive.

The second issue is that potential causes for eating disorder symptoms are not just psychiatric. Many medical conditions mimic eating disorders. Simply making the diagnosis and starting treatment often means people are getting help for a completely inappropriate condition. Many gastrointestinal diseases, ARFID and metabolic dysfunction are some of the most common alternate causes for eating disorder symptoms. However, there are many other options which need to be considered depending on a person’s specific symptoms and experience.

Trauma belongs in its own category of eating disorders. For most of these patients, the eating disorder symptoms are a means to cope with the symptoms of PTSD. The food behaviors can be calming, create order out of chaos and structure daily life. The only way to make change is to address the PTSD symptoms first to enable the person to begin to let go of the eating behaviors slowly and carefully. Traditional eating disorder treatment will be much too dysregulating. Severe PTSD appears to be more akin to a neurological disorder than psychiatric and needs very individualized care.

All of this information shows that people with eating disorder symptoms need a thorough initial assessment. The clinician needs to be able to sort through possible causes of the eating disorder, refer to other specialists if necessary and ensure the path of care is appropriate.

The increasing breadth of knowledge about eating disorders continues to expand treatment guidelines and opportunities while changing the guidelines for an assessment. These changes also demand a comprehensive first appointment before starting treatment.

The Needed Components of a Thorough Assessment of Eating Disorders and Implications for Treatment

The tendency to consider eating disorders as a homogeneous set of illnesses is misleading and frankly incorrect. They comprise a broad set of symptoms that are all include a focus on food, hunger and weight but typically manifest in very different ways.

Broad knowledge of how hunger, fullness, metabolism and weight are maintained by the body and mind is necessary to grapple with the healing process from an eating disorder. However, the treatment recommendations can vary greatly.

In this post I will explain some of the more general ways to differentiate eating disorders and elaborate more in upcoming posts.

Some eating disorder treatment is different based on the concomitant psychiatric diagnoses that need treatment with the eating disorder. The most common ones are Post Traumatic Stress Disorder, Obsessive Compulsive Disorder Disorder, Major Depressive Disorder and Attention Deficit Disorder.

The first key step is to differentiate whether the eating disorder or other disorders are primary and then to prioritize treatment for the eating disorder or other illness treatment accordingly. Sometimes treating the other disorder actually treats the eating disorder as well.

The second necessary step is to consider medical illnesses that might be a part of the eating disorder. These can include general inflammatory disorders, autoimmune disorders and metabolic disorders. Not enough is known about the connection between eating disorders and medical illnesses yet to lead to a clear path to recovery, but these new concepts for treatment are promising. Often searching for more general treatment for these symptoms, even with a clear diagnosis, can be very helpful in treating the eating disorder

Third, it’s important to consider the overall nature of the eating disorder symptoms in planning an approach for recovery. Cognitive Behavioral Therapy is extremely helpful for many eating disorders especially when binging is a primary symptom. Focusing on exploring and identifying emotions is often critical for people with more limited understanding of their emotions. For some, slow and steady work on changing eating patterns remains central to treatment for a longer period. The nature of types of therapy needs to match each patient’s needs.

A better understanding of eating disorders changes the formulation and course of treatment for people with eating disorders. Thoughtful consideration of all factors is necessary for any treatment to be effective. A thorough assessment and consultation will increase the chance of long-term benefit of any treatment.