How are eating disorders diagnosed?

Written by Emily Costa

Understanding an eating disorder diagnosis can be a challenging journey, but it is an integral first step towards recovery and self-growth. This blog aims to shed light on the significance of obtaining a diagnosis, and how it can pave the way for an individualized treatment plan. A diagnosis not only validates the struggles one is experiencing but also provides clear guidelines on the subsequent steps to be taken for recovery. This process can be daunting, but with the right knowledge and resources, it becomes manageable and less overwhelming.

Continue reading to learn more about:

Who diagnoses an eating disorder
Eating disorder signs and symptoms
How to manage the anxiety and uncomfortability in talking about eating disorder symptoms
What to do if you are not ‘sick enough’
What happens once you are diagnosed with an eating disorder
What is the first step to being diagnosed with an eating disorder

Who diagnoses an eating disorder?

Professionals who can diagnose eating disorders span different fields of expertise, ensuring a comprehensive evaluation of the condition. This typically may include a primary care physician, a psychiatrist or therapist, and/or a registered dietitian. The diagnostic process involves a thorough assessment of both physical and psychological aspects.

From a physical perspective, your primary care physician conducts a series of medical tests to assess the impact of the disorder on your body. This often includes blood tests to check for nutritional deficiencies or organ damage, and bone density tests to determine the presence of osteoporosis. Physical symptoms like heart rate abnormalities, electrolyte imbalances, and significant weight loss or gain are also monitored.

On the psychological side, a psychiatrist or psychologist takes a deep dive into your mental state. They chiefly rely on interviews and questionnaires to evaluate your eating habits, body image perceptions, and emotional well-being. They may use standardized tools like the Eating Disorder Examination (EDE) or the SCOFF questionnaire to quantify symptoms and compare them against diagnostic criteria.

Conversations typically revolve around eating patterns, feelings about weight, body dissatisfaction, and obsessive thoughts about food. They may also delve into any history of anxiety, depression or trauma, as these can often be entwined with eating disorders. By considering both the physical and psychological aspects, professionals can ensure a holistic diagnosis and treatment plan that addresses the root causes of the disorder.

Eating Disorder Signs & Symptoms

Eating disorders are complex mental health conditions that manifest differently in different individuals. They are typically characterized by abnormal or disturbed eating habits and severe distress about body weight or shape. The most common eating disorders include Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder, each demonstrating unique characteristics.

Anorexia Nervosa

Anorexia Nervosa is characterized by extreme weight loss, a distorted body image, and an irrational fear of gaining weight. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the criteria for Anorexia Nervosa include:

Persistent restriction of energy intake, leading to significantly low body weight.
Intense fear of gaining weight or persistent behavior that interferes with weight gain.
A disturbance in the way one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.

Bulimia Nervosa

Bulimia Nervosa involves periods of excessive eating followed by compensatory behaviors such as vomiting, excessive exercise, or extreme dieting. The DSM-5 criteria for Bulimia Nervosa include:

Recurring episodes of binge eating characterized by both eating in a discrete period an amount of food that is definitely larger than most individuals would eat and a lack of control over eating during these episodes.
Recurring compensatory behaviors to prevent weight gain, such as self-induced vomiting, misuse of laxatives, or excessive exercise.
These behaviors both occur, on average, at least once a week for three months.
Self-evaluation is unduly influenced by body shape and weight.

Binge Eating Disorder

Binge Eating Disorder is characterized by recurrent episodes of eating large quantities of food, often very quickly and to the point of discomfort. The DSM-5 criteria for Binge Eating Disorder include:

Recurring episodes of binge eating, typically in a discrete period.
The binge eating episodes are associated with at least three of the following: eating much more rapidly than normal, eating until feeling uncomfortably full, eating large amounts of food when not feeling physically hungry, eating alone due to embarrassment about how much one is eating, feeling disgusted with oneself, depressed, or guilty afterward.
Marked distress regarding binge eating is present, and the binge eating occurs, on average, at least once a week for three months.
The binge eating is not associated with recurrent use of inappropriate compensatory behaviors as in bulimia nervosa.

Now, it's crucial to note that not everyone who has an eating disorder will fall neatly into these categories. That's where Other Specified Feeding or Eating Disorders (OSFED) comes in. OSFED is diagnosed when an individual's symptoms cause significant distress or impairment but do not meet the full criteria for any of the other eating disorders. The individual may exhibit signs and symptoms of several different eating disorders, making their experience no less severe or valid. OSFED underscores that all eating disorders deserve recognition and treatment.

What if I’m uncomfortable talking about my eating disorder symptoms?

It's quite normal to feel anxious or uncomfortable when talking about your eating disorder symptoms. After all, these are deeply personal experiences that can bring up numerous emotions, insecurities, and fears. However, it's vital to remember that expressing your feelings and experiences is a critical step on the path to recovery.

Eating disorder specialists are well-trained professionals who understand the intimate and complex nature of these conditions. They realize that discussing symptoms can be a daunting task, hence they strive to create a safe, non-judgmental environment where you can feel comfortable sharing your thoughts and feelings. They are there to listen, understand, and provide support without any bias or prejudice.

Remember, these professionals have heard it all. No symptom, experience, or feeling is too strange, embarrassing, or insignificant to mention. They've worked with numerous individuals who've had diverse experiences, and they're prepared to meet you where you are in your journey. They understand that each person's experience with an eating disorder is unique, and they are equipped to handle a wide range of situations and symptoms.

Moreover, these specialists recognize the courage it takes to open up about such personal matters. They are deeply committed to treating each client with the utmost respect and kindness. Their goal is to guide you through the process of understanding your symptoms, uncovering their root causes, and developing effective strategies for recovery.

Feelings of discomfort or anxiety are part of the process, but they don't have to be obstructions. The right professional will respect your pace and comfort level, always ensuring that you feel heard, understood, and comfortable. Your journey to recovery might seem challenging, but please remember that you're not alone. Help is available, and a skilled eating disorder specialist is ready to stand by your side every step of the way.

What if I’m not sick enough to be diagnosed with an eating disorder?

A common misconception about eating disorders is the notion that one has to reach a certain level of severity or "sickness" to qualify for treatment. Many people struggling with disordered eating or body image issues fear that they are not "sick enough" and this thought often prevents them from seeking help. However, this could not be further from the truth. Any struggle with food or body image, no matter how minor it may seem, is worthy of attention and care. Early intervention is key to preventing the escalation of these conditions. Remember, you do not have to reach rock bottom to justify seeking treatment. Eating disorders and disordered eating exist on a spectrum, and all points on that spectrum deserve recognition, support, and care. No issue is too small, and no one is "not sick enough". Everyone deserves help, everyone deserves treatment, and everyone deserves recovery.

What happens once you are diagnosed with an eating disorder?

Once diagnosed with an eating disorder, a structured treatment plan is set in motion. This typically begins with a therapist who has specialized training in eating disorders. They work with you to understand your specific needs and circumstances and formulate a treatment plan accordingly. Frequently, this involves a multidisciplinary approach, where the therapist collaborates with a dietitian and primary care physician.

The dietitian is crucial in guiding you towards healthful eating patterns, while the primary care physician monitors your physical health to ensure there are no medical complications due to the eating disorder. This collaborative care usually takes place on an outpatient basis, allowing you to live at home while you attend scheduled appointments.

However, depending on the severity of your condition, a higher level of care may be necessary such as a treatment program. This might mean referral to an intensive outpatient program or partial hospitalization program, where you receive treatment for several hours a day while still residing at home. Alternatively, you may be referred to a residential treatment program, where you live in a therapeutic community while receiving round-the-clock care and supervision.

Remember, the goal of this process is to provide the level of care that is most appropriate for your specific situation, ensuring that you receive the support, tools, and treatment needed to effectively navigate your recovery journey.

What is the first step to being diagnosed with an eating disorder?

The initial step towards being diagnosed with an eating disorder is reaching out for help. This could mean contacting a treatment center that specializes in eating disorders, consulting with an eating disorder therapist, or even discussing your concerns with your primary care physician. These professionals are equipped to understand your symptoms and can guide you towards the appropriate treatment path. It may seem like a daunting step, but remember that taking this first step is a significant milestone towards recovery.

The Admissions team here at Central Coast Treatment Center is always ready to assist you. We understand the courage it takes to initiate this journey and are dedicated to supporting you every step of the way. We are prepared to answer your questions and address your concerns, to help you begin your journey towards recovery with compassion and respect. Remember, you are not alone in this. Help and support are available, and your path to recovery can start today. Reach out to us now.

Emily Costa

Having struggled with an eating disorder herself, Emily is passionate about spreading awareness, education and the possibility of recovery with others. Emily previously volunteered as a Crisis Text Line counselor and with the eating disorder non-profit Project HEAL where she served as their blog manager, their NYC Chapter Leader & a recovery mentor in their Communities of HEALing pilot program completing training by the Carolyn Costin Institute. Emily now enjoys working with various treatment centers, clinicians and non-profits in the eating disorder community providing marketing and design services. In her free time she enjoys spending time with friends, hanging with her dogs, and reading a book at the beach.

Ai PonoOctober 4, 2023