• Screening Questions
  
• Possible Presentations of Eating Disorders
  
• Criteria for Diagnosis of Eating Disorders
  
• Information for Referrals
  
• Journals

Screening Questions

• Are you worried about your weight?
  
• Are you dieting?
  
• Have you lost weight?
  
• Do you experience binge eating?
  
• Do you purge after meals?
  
• Do you feel your exercise is out of control?
  

Possible Presentations of Eating Disorders

Clinical Feature Cause

• Weight loss from self-starvation, purging, or compulsive exercise
  
• Amenorrhea or decreased sexual drive and function
  
• Abdominal pain or distention, malnutrition
• Electrolyte imbalance
  
• Loss of tooth enamel from repeated vomiting
  
• Esophagitis or esophageal tears
  
• Lanugo hair (fine downy hair of childhood)
  
• Fracture from minimal trauma due to loss of bone density
  
• Presence of laxatives, diuretics or signs of vomiting
• Abnormal laboratory and radiologic findings
  
• Metabolic alkalosis from repeated vomiting
  
• Hypokalemia from vomiting, diuretic or laxative abuse
  
• Anemia, malnutrition
  
• Low serum estrogen levels, suppression of GnRH and gonadotropins, low testosterone
  
• Hyperprolactinemia
  
• Osteopenia
• Osteoperosis

Criteria For Diagnosis of Eating Disorders

Anorexia Nervosa (Restricting Subtype)

• Self-induced starvation to less than or equal to 85 percent of normal weight
  
• Irrational fear of becoming fat
  
• Hypoganadism, in women: amenorrhea for three months; in men: decreased libido, decreased sexual drive
  
• Distortion of body image*
  

Anorexia Nervosa (Bulimic Subtype)

• All criteria for the restricting subtype, as above
  
• Binge eating twice/week for three months, on average
  
• Purging (vomiting, laxative or diuretic abuse) or other compensatory (fasting, over-exercise) actioin to avoid weight gain*
  Bulimia Nervosa**
  
• Binge eating twice/week for three months
  
• Purging (vomiting, laxative or diuretic abuse) to avoid weight gain*
  
• Irrational fear of becoming fat
  
• Weight normal or high
  
• Distortion of body image*
  
• Note: 20 percent do not purge but follow binges with self-starvation or compulsive exercise.
  

* Found in many patients, but not a diagnostic criterion
** Note: many cases do not fit strictly into one of these categories, which are somewhat narrow, but may be equally serious and respond just as well to treatment. Example: weight loss of greater than 15 percent with continued menstrual periods; binge-eating less than twice a week.

These cases are called "sub-syndromal," "atypical," or "eating disorder not otherwise specified" (EDNOS) by the current formal but overly rigid classification.

Information for Referrals

Please include the following information when you refer a patient:

• Clinical history (Physical within the last 30 days is helpful)
  
• Clinical summary (Diagnostic evaluations, discharge summary)
  
• Pertinent progress notes
  
• Current medications list
  

Journals

• International Journal of Eating Disorders
  Michael Strober, PhD, Editor-In-Chief
  Department of Psychiatry
  UCLA, Neuropsychiatric Institute
  7600 Westwood Plaza
  Los Angeles, CA 90024
  
• Eating Disorder Program: The Journal of Treatment and Prevention
  Leigh Cohn, M.A.T.
  Brunner/Mazel, Inc.
  19 Union Square West
  New York, NY 10003
  212-924-3344