The first step in diagnosis is admitting that you have symptoms of an eating disorder. You may need support and encouragement from others before seeking help.

Initial evaluation—During the initial evaluation, your healthcare provider will ask about your symptoms and medical history, the amount of food you eat, and how you try to control your weight.

Physical exam and tests—Your healthcare provider will give you a physical exam and check your height and weight. If you have symptoms of bulimia, he or she may look at your teeth to check for erosion (a sign of frequent vomiting). You will also have routine blood, urine, and other tests to check your overall health status.

Psychiatric evaluation—A mental health professional may perform a series of tests and evaluate you for other psychiatric conditions, such as depression and anxiety disorders, which are common in people with eating disorders. Diagnosis of a particular type of eating disorder is based on an evaluation of your symptoms using the criteria of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Screening tests such as the Eating Attitudes Test (EAT-26) can be used to screen for symptoms of eating disorders.

Diagnosis of Anorexia Nervosa

According to the DSM-IV, anorexia nervosa is characterized by:

• An intense fear of gaining weight
• A refusal to maintain adequate nutrition, often associated with an erroneous image of the self as fat
• Loss of original body weight to 85% or less of what is expected for normal height and weight
• Disturbance of body image and negative self-evaluation
• Absence of at least three consecutive menstrual periods in females who have started menstruating

Diagnosis of Bulimia Nervosa

According to the DSM-IV, bulimia nervosa is characterized by:

• Frequent occurrence of binge eating episodes accompanied by a sense of loss of control
• Recurrent inappropriate behavior (ie, vomiting, use of laxatives, fasting, or excessive exercise) intended to prevent weight gain
• Both of the above behaviors occur at least twice a week, on average, for three months
• Negative self-evaluation influenced by body shape and weight

Diagnosis of Binge Eating Disorder

Binge eating disorder is characterized by:

• Binge eating episodes accompanied by a sense of loss of control
• No inappropriate behavior to prevent weight gain
• The behavior occurs at least twice a week, on average, for three months

References:

Abnormal Psychology and Modern Life. 11th ed. Allyn and Bacon; 2000.

American Psychiatric Association. Diagnosis and Statistical Manual of Mental Disorders. 4th ed. Text Revision. Washington, DC: American Psychiatric Association; 2000.

Anorexia Nervosa and Related Eating Disorders website. Available at: http://www.anred.com/toc.html. Accessed April 8, 2007.

General information. National Association of Anorexia Nervosa and Associated Disorders. Available at: http://www.anad.org/site/anadweb/content.php?type=1&id=6982. Accessed April 8, 2007.

National Association of Anorexia Nervosa and Associated Disorders website. Available at: http://www.anad.org/site/anadweb/.

Yager J, Devlin MJ, Halmi KA, et al. Practice Guideline for the Treatment of Patients with Eating Disorders. 3rd ed. American Psychiatric Association; 2006. Available at: http://www.psych.org/psych_pract/treatg/pg/EatingDisorders3ePG_04-28-06.pdf. Accessed April 8, 2007.

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