National Eating Disorders Association

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 immediately.

Early detection, initial evaluation, and effective treatment are important steps that can help an eating disorder sufferer 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

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

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

Medical Exam

Eating disorders are frequently accompanied by various medical issues that can result from self-starvation, 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:

  • Physical examination including height, weight, body mass index (BMI), growth chart assessment for children and adolescents, cardiovascular and peripheral vascular function, skin health, hair loss, evidence of self-injurious behaviors 
  • Measurement of body temperature and pulse 
  • Orthostatic blood pressure 
  • Laboratory tests (see below) 
  • Dental exam if self-induced vomiting is known or suspected 
  • Establishment of diagnosis and recommendations for appropriate level of care

Laboratory Testing

A variety of laboratory tests and bloodwork 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:

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

The tests, in more detail: 

  • Complete Blood Count (CBC) 
    • This analyzes the three main types of blood cells circulating in your blood, and can detect anemia and infection
  • Comprehensive Metabolic Profile
    • 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 (a by-product of fat metabolism that occurs when the body doesn’t have enough fuel) and the urine specific gravity, which can assess dehydration and fluid intake

Laboratory Testing for Medical Professionals 

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

  • 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, phosphate 
  • Thyroid screen (T3, T4, TSH) 
  • Electrocardiogram (ECG)

Special Circumstances

  • If uncertain of diagnosis 
    • Erythrocyte sedimentation rate 
    • Radiographic studies (computed tomography or magnetic resonance imaging of the brain or upper/lower gastrointestinal system)
  • For individuals with persistent low weight, especially females who sustain amenorrhea, a work-up should include a Dual Energy X-ray Absorptiometry (DEXA) to assess bone mineral density.
  • If applicable, if patient has been without a menstrual period for six or more months 
    • Urine pregnancy, luteinizing and follicle stimulating hormone, and prolactin tests

References:

Peterson, C. B., Miller, K. B., Johnson-Lind, J., Crow, S. J., & Thuras, P. (2007). The accuracy of symptom recall in eating disorders. Comprehensive psychiatry, 48(1), 51-56.

Rome, E. S., Ammerman, S., Rosen, D. S., Keller, R. J., Lock, J., Mammel, K. A., ... & Schneider, M. (2003). Children and adolescents with eating disorders: the state of the art. Pediatrics, 111(1), e98-e108.

Walsh, B. T., & Kahn, C. B. (1997). Diagnostic criteria for eating disorders: Current concerns and future directions. Psychopharmacology bulletin, 33(3), 369.

Walsh, B. T. (2007). DSM‐V from the perspective of the DSM‐IV experience. International Journal of Eating Disorders, 40(S3).

Walsh, J. M., Wheat, M. E., & Freund, K. (2000). Detection, evaluation, and treatment of eating disorders. Journal of general internal medicine, 15(8), 577-590.