Eating Disorders - Diagnosis

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Diagnosing Bulimia Nervosa

In spite of the prevalence of bulimia, in one study only 30% of Midwest family doctors had ever diagnosed bulimia in a patient. Younger and female doctors are more likely to detect bulimia. A doctor should make a diagnosis of bulimia if there are at least two bulimic episodes per week for 3 months. Because people with bulimia tend to have complications with their teeth and gums, dentists could play a crucial role in identifying and diagnosing bulimia.

Diagnosing Anorexia Nervosa

Generally, an observation of physical symptoms and a personal history will quickly confirm the diagnosis of anorexia. The standard criteria for diagnosing anorexia nervosa are:

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• The patient's refusal to maintain a body weight normal for age and height
• Intense fear of becoming fat even though underweight
• A distorted self-image that results in diminished self-confidence
• Denial of the seriousness of emaciation and starvation
• The loss of menstrual function for at least 3 months

The doctor then categorizes the anorexia further:

• Restricting (severe dieting only)
• Anorexia bulimia (binge-purge behavior)

Because the disorder rarely shows up in men, doctors may not be on the lookout for it in male patients, even if they show classic symptoms of anorexia. Doctors should be very aware of these symptoms in anyone, particularly in athletes and dancers.

Diagnosing Complications of Eating Disorders

Once a diagnosis is made, doctors should immediately check for any serious complications of starvation. They should also rule out other medical disorders that might be causing the anorexia. Tests should include:

• A complete blood count
• Tests for electrolyte imbalances (low potassium levels mean the disorder is more likely to be accompanied by the binge-purge syndrome)
• Test for protein levels
• An electrocardiogram and a chest x-ray
• Tests for liver, kidney, and thyroid problems
• A bone density test

Review Date: 12/13/2006
Reviewed By: Harvey Simon, MD, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital.