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.