ESP (eating disorder screen for primary care) [2]
• Are you satisfied with your eating patterns? (A “no” to this question was classified as an abnormal response)
• Do you ever eat in secret? (A “yes” to this and all other questions was classified as an abnormal response)
• Does your weight affect the way you feel about yourself?
• Have any members of your family suffered with an eating disorder?
• Do you currently suffer with or have you ever suffered in the past with an eating disorder?
SCOFF [3]
• Do you make yourself Sick because you feel uncomfortably full?
• Do you worry you have lost Control over how much you eat?
• Have you recently lost more than One stone (14 lbs or 7.7 kg) in a three-month period?
• Do you believe yourself to be Fat when others say you are thin?
• Would you say that Food dominates your life?
3.3 Differential Diagnosis
When evaluating Cassandra, Ms. Dunning would want to assess for the presence of a full-syndrome eating disorder. As Cassandra was not of low weight, she would not fulfill criteria for anorexia nervosa. Her episodes of eating more at night rarely involved eating enough to qualify as a binge (she was typically eating a somewhat larger than normal, but not excessive, portion); on occasion, she would eat a much larger amount and feel like she had no control to stop (consistent with a binge), but these episodes happened rarely. Based on this, the diagnoses of bulimia nervosa and binge eating disorder are not appropriate.
It could be argued that it would be appropriate to give her a diagnosis of other specified feeding or eating disorder (OSFED), which would describe subsyndromal symptoms and behaviors that are causing distress or impairment of functioning but not fully meeting the criteria of one of the DSM-5 feeding and eating disorder diagnoses. For example, if she were engaging in binge eating on a regular basis, causing significant impairment in an area of life functioning, but the binges were happening less frequently than once a week, she could be given the diagnosis of OSFED (binge eating, with subsyndromal frequency). One diagnosis that has not yet been included as a separate diagnosis in the feeding and eating disorder chapter of DSM-5, but that has been described in the literature and is mentioned in the DSM, is night eating syndrome (NES). Individuals with NES will consume a large percent of their daily calories at night at least twice a week and will have associated distress or impairment associated with their symptoms. This diagnosis does not fit Cassandra’s presentation on the basis of frequency, but would be something to consider and evaluate as part of the differential diagnosis.
Unspecified feeding or eating disorder is a preliminary diagnosis that would be given to an individual with eating disorder symptoms or behaviors that are causing distress or impairment but where there is not enough information at the time of assessment to further qualify the diagnosis with any specificity.
Related posts:
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
