1. Diagnosis & Assessment Eating Disorders Criteria Complexity Issues

2. Core Concept of Diagnostic Group Obsessive concern about becoming overweight or fat Distorted body image Inability to appropriately control food intake to maintain healthy body weight Fluctuation of self-evaluation dependent on perceived body shape or weight

3. Criteria Applicable to Multiple Disorders One criterion – common to both Anorexia Nervosa & Bulimia Nervosa Individual’s self-evaluation is unduly influenced by his/her body weight or shape

4. Necessary Clinical Information Current & past weight Current & past patterns of eating Current & past feelings about food Unusual eating rituals Current & past appetite History of dieting Current & past feelings about weight Medical Illnesses Current meds & abused substances Psychiatric illnesses Psychiatric symptoms (mania, anxiety, etc Episodes of binge eating Psychological conflicts related to self-evaluation (i.e., self- esteem) Relationship between weight & patient’s self-esteem Family history of eating disorders

5. Making a Diagnosis Characterized by – ever-changing interaction between amount of food consumed –individuals’ perception of weight or shape –& relationship of perception to self-esteem

6. Questions for Diagnosis Does individual body weight or shape have undue influence on self-evaluation & does individual fear gaining weight Does individual refuse to maintain body weight above a minimum (e.g., 85%) of expected normal weight for age & height?

7. More Questions Does individual binge eat? Does an individual have an eating disturbance that doesn’t meet the criteria for a specific eating disorder? –Problem is sometimes one of interpretation rather than total absence of criteria

8. Precedence of a Diagnosis Presence of any nonpsychiatric medical disorder causing weight loss takes precedence over AN Diagnosis of Anorexia precedence over Bulimia Nervosa If individual with Schizophrenia has serious weight loss & meets AN criteria –both diagnosis given Individual with Borderline Personality Disorder who binges meets criteria for Bulimia Nervosa –both diagnoses given

9. Necessity of Comprehensive, Multidimensional Assessment Many new self-report measures Revisions of established instruments

10. Relevance of Assessment Assessment as a process –May occur over several sessions Assessment serves multiple services –Diagnosis –Information for treatment planning Assessment of severity & associated symptomatology necessary to treatment planning –Heterogeneity in eating-related symptoms –Comorbid pathology Assessment as multimodal

11. Multimodal Nature of Assessment Information from interviews Carefully selected battery of self-report instruments/questionnaires Self-monitoring data –Diaries –3x5 cards

12. Interview: Making Diagnosis Clinical Concepts –Obsessive concern about becoming overweight or fat –Distorted body image –Inability to appropriately control food intake to maintain a healthy body weight –Fluctuation of self-evaluation dependent on perceived body shape or weight

13. Interview: Weight & Body Image Current weight & height –with weight history –highest & lowest weights since attaining current height –Frequency of weight fluctuations –Perceptions of weight early in life –Consideration of client’s ideal weight Significant life events & relation to weight fluctuations –Emerging patterns Insight of client

14. Interview: Body Image Disturbance Disturbance in perception –Body image distortion Selected body parts as unrealistically large Disturbance in cognition & affect –Body image dissatisfaction Appearance evaluated negatively Disturbance in behavior –Body checking –Avoiding anxiety provoking situations

15. Interview: Ideal Weight Questions about “feeling fat” Meaning attached to attaining/maintaining ideal weight Impact weight gain/loss on thoughts & feelings about self Others’ perceptions of her weight & shape Degree of avoidance/restriction in activities involving body exposure

16. Interview: Abnormal Eating Behaviors Binge Eating –Context within which the eating occurs –Onset –Frequency –Severity Topographical information –Description of daily eating patterns Typical meal Typical binge Avoided foods; foods causing distress –Timing of binges –Antecedents & consequences

17. Interview: Weight Control Measures History of dieting –Triggered by episodes of bingeing –Frequent weighing –Onset, frequency, & preferred methods of diet Emphasize most recent period of dieting –To assess connection to stressors –Compensatory methods – close-ended questions more successful –Specific terms as self-induced vomiting, laxatives, diuretics, enemas, appetite suppressants, other meds, fasting, excessive exercise

18. Self-Report Questionnaires Multiple uses Expand assessment process Screening instruments for symptomalogy & severity Inform treatment planning by identifying & clarifying issues requiring emphasis Incorporate other general psychological distressors

19. Self-Report: Body Image Disturbance Delineate components of body image disturbance to target –Body size distortion: Correction of size & weight overestimation Techniques for estimating body part size Distorting-image techniques –Body image dissatisfaction: modify negative & distorted thinking Body Cathexis scale & Eating Disorders Inventory-2 body dissatisfaction subscale –Body image avoidance: incorporating exposure to situations Body Image Avoidance Questionnaire

20. Self-report: Maladaptive Eating Attitudes, Behaviors, & Cognitions Measures of treatment progress & outcome –Eating Attitudes Test (EAT) –EDI-2 –BULIT-R –Forbidden Food Survey –Bulimic Thoughts Questionnaire (BTQ) –Mizes Anorectic Cognitions (MAC) questionnaire –Bulimic Cognitive Distortions Scale

21. Self-Report:Assessment of General Psychopathology Self-Report Prior or simultaneous intervention Minnesota Multiphasic Personality Inventory-2 (MMPI-2) Personality Diagnostic Questionnaire— Revised (PDQ-R) Symptom Checklist 90

22. Self-Monitoring: Naturalistic Assessment Eating Diaries – self-developed or published –Detailed information about eating behavior –Focal point of intervention Clarify relationship between events & binge episodes Awareness of internal states to eating/restriction of eating –Examine treatment progress & outcome Topographical information –Frequency, timing, meals, snacks, binge episodes –Compensatory weight control methods –Types & quantities of food consumed –Information about location, persons present, affect & thoughts, –Nutritional composition