Eating disorders: Clinical

An eating disorder is a mental disorder characterized by abnormal eating habits that negatively affect a person's physical or mental health. Eating disorders are quite common, and while in many cultures there is a misconception that they only affect women, they can, in fact, affect anybody regardless of gender or sex, but most often occur in teenagers who struggle with low self-esteem and the social pressure to look a certain way. They’re tied to both biological factors - like genetics and hormones, as well as environmental factors - like psychosocial pressure to have the socially-defined “ideal body” perpetuated by social and traditional media, or having careers that promote weight loss like modeling and sports; also bullying, loneliness, and childhood trauma are all linked to eating disorders. The most common eating disorders include anorexia nervosa, bulimia nervosa, and binge-eating disorder. Besides that, there are other conditions, which include umination, avoidant or restrictive food intake disorder, and finally pica. There are also two other diagnoses, other specified eating disorder, and unspecified eating disorder, reserved for symptoms that don't fit any of the primary disorders. If an individual is suspected to have an eating disorder, a number of screening instruments have been developed to identify those who need further evaluation. A very simple instrument is the SCOFF questionnaire, which consists of five questions. The acronym SCOFF relates to one of the words in each question - Sick, Control, One, Fat, and Food. The questions are: Do you make yourself Sick because you feel uncomfortably full? Do you worry you have lost Control over how much you eat? Have you recently lost more than One stone - so 14 pounds or 6.35 kilograms - in a three-month period? Do you believe yourself to be Fat when others say you are too thin? And finally, would you say that Food dominates your life? One point is assigned for every "yes"; and a score of two or greater indicates the need for further assessment. A second five-question tool, the clinician administered Eating Disorder Screen for Primary Care, can also be used for screening. The questions are: Are you satisfied with your eating patterns? Answering “no” is considered abnormal. Do you ever eat in secret? Answering “yes” is abnormal. Does your weight affect the way you feel about yourself? Answering “yes” is abnormal. Have any members of your family suffered with an eating disorder? Answering “yes” is abnormal. And finally, do you currently suffer with or have you ever suffered in the past with an eating disorder? Answering “yes” is abnormal. Any abnormal response here indicates the need for further assessment. A diagnosis of anorexia nervosa requires three things. First, individuals must eat less than their daily requirement to survive based on their age, sex, and level of activity - which leads to a low Body Mass Index or BMI. A body mass index, or BMI, between 18.5 and 24.9 is considered healthy, in mild anorexia the BMI is between 17 and 18.5, in moderate anorexia the BMI is between 16 and 17, in severe anorexia the BMI is between 15 and 16, and in extreme anorexia, the BMI is below 15. Second, individuals have a constant fear of gaining even a small amount of weight or having persistent habits that prevent weight gain, even at significantly low weight. And third is having a distorted impression of their body, with individuals often believing that they are overweight, while actually being underweight, or they don’t recognize the seriousness of how underweight they are. People who meet all the criteria for anorexia except that they are within or above the normal weight range after significant weight loss can be diagnosed with atypical anorexia nervosa.