Eating disorders are serious mental illnesses that are associated with a broad range of medical and psychiatric problems, including increased risk of mortality (Crow, 2005; Crow et al., 2009). Although the prevalence of eating disorders is less than 5% of the general population (Hoek & van Hoeken, 2003; Swanson, Crow, Le Grange, Swendsen, & Merikangas, 2011), some studies have found much higher rates of subthreshold eating disorder symptoms in adolescent and young adult females (e.g., weekly binge eating or weekly self-induced vomiting; Berg, Frazier, & Sherr, 2009). Historically, eating disorders were thought to be problems limited to Caucasian females from privileged backgrounds. However, more recent epidemiological research has demonstrated that eating disorders are increasingly common in broader age ranges, both genders, and diverse ethnic groups (Swanson, Crow, et al., 2011). Additionally, although weight status or changes in weight status can be indicative of an eating disorder, individuals presenting at normal weight or without significant weight changes may suffer from eating disorders as well. Thus, because there are significant medical and psychiatric risks associated with eating disorders and disordered eating, because eating disorders are not restricted to any specific subgroup of clients, and because eating disorders may not be visually apparent, we recommend that the assessment of eating disorders should be considered ah essential element of an intake assessment in all counseling settings and with all clients.
Although assessing eating disorders may seem like a daunting prospect to some, it can have enormous benefits for both therapy outcome and the therapeutic relationship (Peterson, 2005). First, assessment is the foundation of ongoing treatment because it informs diagnosis, guides treatment planning, and can be used to measure progress and outcome. Careful assessment can also be used to detect potentially serious medical and psychiatric complications and, in some cases, determine treatment priorities. Finally, assessment has been found to produce improvement in eating disorder symptoms and, when conducted well, it can facilitate trust and reduce the likelihood of attrition (Peterson, 2005).
The book Assessment of Eating Disorders (Mitchell & Peterson, 2005) represents the most comprehensive resource for clinicians and researchers interested in eating disorder assessment; however, this resource may be most applicable to counselors who regularly treat eating disorder clients and may be too specialized for many professional counselors. Recommendations for eating disorder assessment are also provided in a recently published article (Anderson, Lundgren, Shapiro, & Paulosky, 2004); however, these recommendations are largely constrained to the use of structured assessment tools such as semistructured interviews and self-report questionnaires. Although there are advantages to using structured assessments, the clinical interview remains the most common assessment modality in professional counseling (Jones, 2010). Because there are no published guidelines for professional counselors on incorporating eating disorder assessment into a clinical interview, we outline recommendations for the assessment and diagnosis of eating disorders that (a) specifically focus on assessment in the context of a clinical interview and (b) can be used by counselors whether or not they specialize in eating disorder treatment. As such, this article will cover the following: (a) the diagnostic criteria for eating disorders, (b) how to integrate assessment of eating disorders into an unstructured clinical interview, and (c) special considerations during an eating disorder assessment.
* Diagnostic Criteria for Eating Disorders
The Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association [APA], 2000) recognizes two formal eating disorders: anorexia nervosa and bulimia nervosa. …