Assessing Eating Disorders and Somatization Disorder

Screening Questions

Eating disorders: Have you ever thought you were overweight?
Somatization disorder: Have you had a lot of unexplained illnesses?

EATING DISORDERS

KEY POINT

Eating disorders are relatively easily diagnosed (Tables 29.1 and 29.2). The problem is that many clinicians don’t ask about them, and many sufferers don’t volunteer their symptoms, either because they aren’t bothered by them, as in anorexia, or because they’re too ashamed of them, as in bulimia. Furthermore, clinicians rarely ask men about eating disorders, even though studies have estimated that 10% to 15% of all patients with eating disorders are men, with an especially high prevalence in gay men (Carlat et al. 1997). Therefore, screening questions for eating disorders should always be included in your PROS.

When time is truly of the essence, you can begin with a direct question:

Have you ever had an eating disorder, such as anorexia or bulimia?

However, if you have the sense that your patient may be particularly ashamed of a suspected eating disorder, a too blunt approach might endanger the therapeutic alliance. In these cases, you can approach the issue more indirectly:

Have you ever thought you were overweight?

If the answer is “no,” it is unlikely that your patient has an eating disorder. If the reply is “yes,” continue.

TABLE 29.1. DSM-IV-TR criteria for anorexia nervosa

Mnemonic: Weight Fear Bothers Anorexics
	Refusal to maintain body Weight above 85% of expected weight
	Intense Fear of gaining weight or becoming fat
	Distorted Body image
	For women: Amenorrhea (the absence of at least three menstrual cycles)
Adapted from American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Text revision. Washington, DC: American Psychiatric Association.

Have you ever dieted?

Almost everyone, and women in particular, has dieted at some point. You’re probing here for a particularly severe diet, perhaps a starvation diet (i.e., fasting) or a diet in which, for example, the patient ate only salad or fruit.

Only gold members can continue reading. Log In or Register to continue