Eating disorder diagnosis process

The eating disorder assessment and diagnosis process

At each stage of an eating disorder assessment, the assessor will act respectfully and with compassion. As trained professionals, they understand how difficult it is to live with this kind of condition. At all times, you should know that you’re in a safe, compassionate and confidential environment, designed to help you.

Eating disorder assessments review your dietetic and therapeutic needs, helping to better understand your needs and how treatment might help you. Together, we’ll develop a picture of your ongoing challenges, physical and mental health, and relationship with food. While eating disorder assessments don't all follow the same structure, most will touch on the same areas – as outlined by National Institute for Health and Care Excellence (NICE) guidelines.

Reviewing your symptoms

During the early stages of assessment and then diagnosis, you’ll be encouraged to discuss the symptoms you’re currently experiencing.

Some common signs of an eating disorder include:

• Unusually low or high body mass index (BMI)
• Rapid weight loss
• Severe changes in eating behaviour, including dieting or restrictive eating practices
• Mental health problems or social withdrawal
• Excessive concern about body weight or shape
• Behaviours that compensate for eating practices, such as laxative misuse, vomiting or excessive exercise
• Poor control of chronic diseases affected by diet (such as diabetes or coeliac disease)
• Physical signs of malnutrition, like poor circulation, dizziness, palpitations or fainting

The signs and typical behaviours displayed can vary significantly depending on the type of eating disorder you may be struggling with. For example, anorexia nervosa, a condition defined by restrictive eating, may focus on extreme weight loss or distorted body image. This contrasts with binge eating disorder (BED), where people feel compelled to eat to excess, to the point where they feel uncomfortably full.

Screening questions

The professional that’s completing the assessment might also use screening questions to get an idea of your relationship with food. An example might be the SCOFF questionnaire, which includes the following five questions:

1. Do you ever make yourself Sick because you feel uncomfortably full?
2. Do you worry that you have lost Control over how much you eat?
3. Have you recently lost more than One stone in a 3-month period?
4. Do you believe yourself to be Fat when others say you are too thin?
5. Would you say that Food dominates your life?

If you respond ‘yes’ to two or more of these questions, this can suggest that you may be struggling with an eating disorder like anorexia nervosa or bulimia nervosa.

Family and personal history

During treatment and recovery, there will be a lot of focus on the underlying causes of your eating disorder. These will vary depending on the person, but things like existing mental or physical health conditions, family history, personal trauma and underlying genetics can all play a role.

During a diagnosis, you'll also touch on these areas, so we can develop a picture of your challenges over time. You’ll be asked about your long-term relationship with food, your weight and your body, any physical ailments that might be contributing to your condition, and questions around your mental health.

You might also go into your current stressors at home, work or school, issues with alcohol or drug misuse, and details about your family’s history with physical and mental health. All of the above can be linked to eating disorders.

Physical assessment

A physical examination, which helps to establish a picture of how your eating habits have affected your body and overall health, is also part of an eating disorder assessment.

This will include things like your BMI and vital signs like your temperature and blood pressure. You might also be asked to sit up or squat, as these are ways to determine your muscle strength and identify any weakening in your muscles. In some circumstances, you might also have blood tests to establish more about your physical health.