Michele Yeo Elizabeth Hughes
Early identification in general practice
Eating disorders are serious illnesses that affect both the physical and socio-emotional health of young people; they have significant impact on families and cause significant mortality and morbidity. The main eating disorders comprise: â€¢ anorexia nervosa (AN) â€¢ bulimia nervosa (BN), and â€¢ ating disorders not otherwise specified (EDNOS), ie. e eating disorders that do not fully meet the criteria for either AN or BN. Although eating disorders are rare in the general population, they are relatively common in teenagers and young women. Eating disorders represent the ...view middle of the document...
Dieting behaviours and body image concerns are common in adolescence and it can be challenging to identify those at the extreme end of this spectrum who are at risk of an eating disorder.
This article presents a brief overview of eating disorders, with a focus on early identification in general practice. An approach to diagnosis is outlined together with an update on evidence based treatments.
General practitioners are uniquely placed to recognise early onset eating disorders, offer intervention and help coordinate and monitor treatment. Early detection and management may contribute to better outcomes.
Keywords: eating disorders; adolescent; young adult; general practice
When does severe dieting become an eating disorder?
Early warning signs of an eating disorder include: â€¢ a constant focus on dieting, food and exercise â€¢ insisting on having different meals from the rest of the family â€¢ feeling stressed when unable to exercise â€¢ increasing social withdrawal â€¢ frequent weighing â€¢ frequent visits to the bathroom after meals.
108 Reprinted from AuSTRAlIAN FAMIlY PhYSICIAN VOl. 40, NO. 3, MARCh 2011
Table 1. DSM-IV diagnostic criteria for common eating disorders2 Anorexia nervosa 1. Refusal to maintain body weight at or above a minimally normal weight for age and height (eg. weight loss leading to maintenance of body weight less than 85% of that expected, or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected) 2. Intense fear of gaining weight or becoming fat, even though underweight 3. Disturbance in the way that body weight, size or shape is experienced, undue influence of body shape and weight on self evaluation, or denial of the seriousness of current low body weight 4. In postmenarchal females, amenorrhoea, ie. the absence of at least three consecutive menstrual cycles Types â€¢ estricting type: during the current episode of anorexia R nervosa, the person has not regularly engaged in binge eating or purging behaviour (self induced vomiting, misuse of laxatives, diuretics, or enemas) â€¢ inge eating/purging type: during the current episode B of anorexia nervosa, the person has regularly engaged in binge eating or purging behaviour (ie. self induced vomiting or the misuse of laxatives, diuretics, or enemas) Bulimia nervosa 1. Recurrent episodes of binge eating. An episode of binge eating is characterised by both of the following: â€¢ ating in a discrete period of time (eg. within any 2 E hour period) an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances â€¢ sense of lack of control over eating during the A episode (eg. a feeling that one cannot stop eating or control what, or how much, one is eating) 2. Recurrent inappropriate compensatory behaviour in order to prevent weight gain such as self induced...