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Eating Disorder Assessment Guidelines

UPMC Content 2

Eating disorders are characterized by a persistent pattern of aberrant eating or diet behaviors, and maladaptive thoughts and beliefs related to eating, shape, or weight.

Eating disorders are associated with significant medical morbidity, as well as psychological distress and dysfunction.

DSM-IV Diagnostic Criteria

Anorexia nervosa

  • Refusal or inability to maintain a minimally normal body weight:
  • Adults: Less than 85 percent of ideal body weight or BMI of 17.5 or lower.
  • Children: Less than 85 percent of body weight expected for age and height. Or, failure to gain weight during a growth period, leading to body weight less than 85 percent of that expected.
  • Intense fear of gaining weight.*
  • Body image disturbance or denial of seriousness of low weight.*
  • Amenorrhea for three months (in postmenarcheal women).
  • *School-aged children may not endorse a fear of gaining weight or body image disturbance.

Two subtypes of anorexia nervosa:

  • Restricting: Patient maintains low body weight by dietary restriction only
  • Binge eating/purging: Patient engages in self-induced vomiting or misuse of diet pills, laxatives, or diuretics


Bulimia nervosa

  • Recurrent binge eating episodes with an associated sense of loss of control over eating.
  • Recurrent use of inappropriate behaviors to prevent weight gain or compensate for the effects of binge eating:
  • Vomiting
  • Laxatives or diet pills
  • Fasting
  • Excessive exercising
  • Both binge eating and purging occur, on average, at least two times per week for three months.
  • Self-evaluation unduly influenced by weight or shape.
  • Does not meet criteria for anorexia nervosa.

Two subtypes of bulimia nervosa:

  • Purging: Patient engages in self-induced vomiting or misuse of diet pills, laxatives, or diuretics to compensate for the effects of binge eating
    Nonpurging: Patient engages in fasting or excessive exercise to compensate for the effects of binge eating

Eating disorder not otherwise specified (NOS)

A residual category that includes persistent patterns of problem eating-related behaviors associated with distress and dysfunction that do not meet criteria for either anorexia nervosa or bulimia nervosa, e.g., recurrent binge eating without the compensatory behaviors seen in bulimia nervosa, or persistent purging behavior without binge eating.

Screening Questions

  1. Do you make yourself vomit because you feel uncomfortably full?
  2. Do you worry that you have lost control over how much you eat?
  3. Have you recently lost 15 pounds or more in a three-month period?
  4. Do you believe yourself to be fat when others say you are too thin?
  5. Would you say that food dominates your life?

One point for every “yes.”
A score of two or more indicates a possible case of anorexia nervosa or bulimia nervosa.
Source: Morgan JF, Reid F, Lacey JH. BMJ 1999;319:1467-1468.


  • Obtain height and weight at each visit
  • Measure height without shoes.
  • Weigh patients wearing gowns.
  • Ask the patient to void before weighing

Routine Laboratory Tests

  • EKG
  • CBC with diff
  • TSH
  • NA, K, Cl, CO2, BUN, creatinine, glucose
  • Liver function tests (ALT, AST, GGTP)
  • Serum calcium, magnesium, phosphorous
  • Urine drug screen
  • Pregnancy test

Review of symptoms and presenting complaints

  • Anxiety
  • Bloating
  • Brittle hair or nails
  • Chest pain
  • Cold intolerance
  • Constipation
  • Depression
  • Diarrhea
  • Dizziness or fainting
  • Fatigue
  • Frequent urination
  • Heartburn
  • Irritability
  • Loss of menses
  • Loss of muscle mass
  • Sleep disturbances
  • Weakness


Findings on Physical Examination

Anorexia nervosa Bulimia nervosa
  • Anemia
  • Bradycardia
  • Edema
  • Emaciation
  • Hyperkeratosis
  • Hypotension
  • Hypothermia
  • Lanugo hair
  • Spontaneous fractures
  • Dental erosions
  • Edema
  • Electrolyte imbalance
  • Esophagitis
  • Extremity weakness
  • GERD
  • Hypertension
  • Normal or overweight
  • Parotid enlargement
  • Sore throat