Evaluation and Diagnosis

How are Eating Disorders Evaluated and Diagnosed?

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These steps are intended for use in a nonemergency situation. If the situation is a medical or psychiatric emergency and the person is at risk of suicide or is medically unstable, call 911, or go to the nearest emergency room.

Early detection, initial evaluation, and effective treatment are important steps that can help a person with an eating disorder move into recovery more quickly, preventing the disorder from progressing to a more severe or chronic state. The following assessments are recommended as the first steps to diagnosis and will help determine the level of care needed. Receiving appropriate treatment is the first step towards recovery.

Patient Assessment

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In order to diagnose an eating disorder and determine the best course of action, a clinician will need to ask the patient and, when possible, their loved ones the following types of questions:¹

• Patient history, including screening questions about eating patterns
• Determination of medical, nutritional, psychological, spiritual and social functioning (if possible, an eating disorder expert should assess the mental health of your child)
• Attitudes towards food, eating, exercise, and appearance
• Family history of eating disorder or other psychiatric disorder, including alcohol and substance use disorders
• Personal and family history of medical illnesses
• Assessment of other mental health conditions, such as depression, anxiety, trauma, OCD, and/or ADHD

Medical Exam

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Eating disorders are frequently accompanied by various medical issues that can result from malnourishment, over-exercise, binge eating, and/or purging. This makes an evaluation by a physician a necessary part of eating disorder treatment. A doctor will typically evaluate the following:¹

• Physical examination including growth chart assessment for children and adolescents, cardiovascular and peripheral vascular function, lung exam, abdominal exam, neurologic exam, skin health, hair loss, and evidence of self-injurious behavior
• Measurement of body temperature and pulse
• Orthostatic blood pressure and pulse
• Weight status focused on changes in weight over time
• Laboratory and imaging tests (see below)
• Dental exam
• Establishment of diagnosis and recommendations for appropriate level of care

Laboratory Testing

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A variety of laboratory tests and blood work may be needed to determine the correct eating disorder diagnosis and assess the appropriate level of care for an affected individual. The laboratory tests will evaluate the following types of factors:¹

• Blood sugar levels
• Electrolyte levels, to determine the presence and severity of dehydration, especially if someone is purging
• Liver and kidney functioning
• Urine analysis and toxicology, if indicated
• Electrocardiogram (ECG), which ensures the heart is beating properly

The tests, in more detail:¹

• Complete Blood Count (CBC):
  • This analyzes the three main types of blood cells circulating in your blood (red blood cells, white blood cells and platelets). This can detect anemia, immune cell dysfunction, and signs of infection
• Comprehensive Metabolic Profile (CMP):
  • The CMP measures a variety of factors related to overall health, including:
    • Blood glucose
    • Electrolytes (sodium, potassium, and chloride)
    • Carbon dioxide (bicarbonate)
    • Blood urea nitrogen (a measure of kidney function)
    • Creatinine and creatinine clearance (a measure of kidney function)
    • Liver enzymes (to measure liver function)
    • Aspartate transaminase (AST)
    • Alkaline phosphatase (ALP)
    • Alanine aminotransferase (ALT)
    • Total bilirubin (to measure liver function)
    • Serum magnesium and phosphate:
      • Both these chemicals play a role in regulating metabolism and heartbeat.
    • Electrocardiogram:
      • This test uses electrical signals from the heart to determine how well it’s beating and if there are any arrhythmias.
    • Urinalysis:
      • This can determine the presence of ketones (which are detected when the body doesn’t have enough fuel) and the urine specific gravity, which can assess dehydration and fluid status.

Laboratory Testing for Medical Professionals

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You can share this list of eating disorder laboratory tests with your doctor:¹

• Complete Blood Count (CBC) with differential urinalysis
• Complete Metabolic Profile: sodium, chloride, potassium, glucose, blood urea nitrogen, creatinine, total protein, albumin, globulin, calcium, carbon dioxide, aspartate transaminase (AST), alkaline phosphatase (ALP), total bilirubin
• Serum magnesium, phosphorus
• Thyroid screen (T3, T4, TSH)
• Electrocardiogram (ECG)

Special Circumstances

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In situations where the diagnosis is uncertain, such as if there is a possibility there might be a brain tumor, gastrointestinal issue, or autoimmune problem the following tests may be recommended:¹

• Erythrocyte sedimentation rate
• Radiographic studies (computed tomography or magnetic resonance imaging of the brain or upper/lower gastrointestinal system)
• For individuals with persistent malnourishment regardless of weight status, especially females who sustain amenorrhea, a work-up should include a Dual Energy X-ray Absorptiometry (DEXA) to assess bone mineral density.
• Depending on clinical presentation, urine pregnancy, luteinizing and follicle stimulating hormone, testosterone, estrogen and progesterone, prolactin

Frequently Asked Questions

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• What type of professional should I go to first for an initial evaluation and diagnosis, a therapist for a clinical assessment or a medical doctor for a physical evaluation?

Start with whichever has more eating disorder specific training and experience that is accessible to the person/family. That is more likely going to be a therapist but look for someone with a CEDS—certified eating disorder specialist. Doctors can have this designation too. Please note this is for non-emergency situations. If you or your loved one are experiencing a psychiatric or medical emergency, call 911, or go to the nearest emergency room.

• What if the doctor doesn’t know about eating disorders?

Unfortunately, expect that your doctor will know little about eating disorders unless they have pursued specialty training or experience in this area. There are guidelines that your doctor can refer to through the Academy for Eating Disorders and the American Psychiatric Association standards of care for eating disorders.