Diagnosis and Treatment of Eating Disorders

Diagnosis

1. Tests to assess physical risk

Eating disorders, unlike other psychiatric disorders, are illnesses in which physical problems and psychosocial problems appear at the same time. Therefore, diagnosing a patient with an eating disorder requires evaluating both aspects.

1. Medical evaluation

· It is important to perform a thorough medical history, physical examination, and neurological examination to assess physical condition, medical risk due to complications, and for differential diagnosis.

· As a basic evaluation, perform a complete blood count, urinalysis, blood uric acid and creatinine levels, electrolytes, serum calcium, magnesium, phosphorus, amylase, liver function tests, electrocardiogram, and chest X-ray.

2. Psychosocial evaluation

· Psychiatric history taking and mental status examination are the core of psychological evaluation. · Psychiatric history

· History of eating disorders and related attitudes or behaviors · Comorbid psychiatric disorders · Developmental problems

· Assessment of interpersonal conflicts and psychodynamic conflicts · Family history

· Social aspects or family assessment, nutritional status assessment, academic and occupational status assessment, etc.

2. Anorexia nervosa

The diagnostic criteria for anorexia nervosa are as follows.

· Refusal to maintain body weight at or above the minimum normal weight for age and height

· Intense fear of gaining weight or becoming fat, despite being underweight

· Disturbance in the way one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight

· Amenorrhea in women of childbearing age, for example, absence of menstruation for three consecutive months

Subtypes of anorexia nervosa

1. Restricting type

During the current episode of anorexia nervosa, there should be no regular binge-eating or purging behavior.

2. Binge-eating/purging type

During the current episode of anorexia nervosa, regular binge-eating or purging behavior should be present.

3. Bulimia nervosa

The diagnostic criteria are as follows.

Recurrent binge-eating episodes have two characteristics:

· In a discrete period of time, eating an amount of food that is definitely larger than most people would eat in a similar period of time or under similar circumstances.

· A sense of lack of control over eating during the episode.

Recurrent inappropriate compensatory behaviors to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, enemas, and other medications, fasting, or excessive exercise / Both binge eating and inappropriate compensatory behaviors occurring, on average, at least twice a week for three months / Self-evaluation unduly influenced by body shape or weight

These disturbances must not occur exclusively during episodes of anorexia nervosa.'

Subtypes of bulimia nervosa

1. Purging type

During the current episode of bulimia nervosa, the patient regularly engages in self-induced vomiting or the misuse of laxatives, diuretics, or enemas.

2. Non-purging type

During the current episode of bulimia nervosa, the patient does not regularly engage in self-induced vomiting or the misuse of laxatives, diuretics, or enemas, but shows other inappropriate compensatory behaviors such as fasting or excessive exercise.

Treatment

1. General guidelines for treating eating disorders

Because eating disorders themselves are illnesses caused by various factors, the therapeutic approach also requires a multidimensional model based on the interaction of physical, psychological, and social factors.

· Outpatient treatment is the rule, but inpatient treatment is necessary in cases where malnutrition becomes a problem due to low body weight, where medical complications are severe, or where serious psychiatric disorders are present.

· The approach should be gradual, dividing goals into short-term goals such as symptom relief, weight restoration, and normalization of eating habits, and long-term goals such as psychosocial adjustment and maintenance of normal weight and eating habits.

· Behavioral therapy approaches are helpful in medical stabilization, nutritional recovery and nutrition education, eliminating abnormal eating attitudes, and forming new eating habits.

· The key to treatment is to restore weight and establish appropriate eating habits before identifying and resolving psychological causes. After that, the patient learns to think differently about weight and the body, discovers life goals that had been hidden behind the eating disorder, and learns how to achieve them in a healthier way.

2. Inpatient treatment for anorexia nervosa

· When weight is rapidly and persistently and severely reduced (weight loss of more than 30% of normal body weight)

· When dangerous changes in vital signs, electrolyte imbalance, or malnutrition are present

· When there is a likelihood of suicide, a suicide attempt, or a psychotic state

· When family problems are so severe that outpatient treatment is impossible

· When social isolation is pathologically severe

· When previous treatment has failed or the patient refuses outpatient treatment due to lack of motivation

3. Treatment of bulimia nervosa

Cognitive behavioral therapy to correct a distorted image of one’s own body is the best treatment. However, when this is not effective, interpersonal psychotherapy can be used as an alternative. In addition, family therapy is useful for bulimia nervosa occurring in adolescent teenagers.

Antidepressants (SSRIs) may also be used, but they are not as effective as cognitive behavioral therapy.

Because weight is within the normal range, bulimia nervosa can basically be treated on an outpatient basis. However, inpatient treatment is necessary when medical problems such as electrolyte imbalance occur together due to inability to control binge eating, medication misuse, frequent vomiting, excessive exercise, or suicidal ideation.

So far, I have explained the diagnosis and treatment of eating disorders.

In the next article, we will look at lacerations.

Source: Korea Disease Control and Prevention Agency National Health Information Portal