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Due to the embarrassment and shame most individuals feel about their eating disorder, they rarely reach out for help until well into their illness, if at all. They many times have to hit "rock bottom" before they work-up the courage to confide in someone about their eating problems.
 
Therefore, a great deal of responsibility rests upon primary care providers to diagnose eating disorders in their patients before their patients become desperate for help and their physical and psychological condition significantly deteriorate.
 
If you are a person with an eating disorder reading this who feels afraid to disclose your problems to a healthcare professional, I encourage you to take the risk, as you will be much better off for having talked to someone about your condition.
 
Find a healthcare professional you feel comfortable talking with. If you feel uncomfortable bringing up the subject with your physician, maybe there is a nurse in the same office you would feel more comfortable talking with.
 
Maybe you would feel more comfortable talking with a mental health counselor, school counselor, or a friend who does counseling. Maybe you would initially prefer calling an eating disorder hotline for information, support, and a referral to a therapist. See the "Resources" page for eating disorder hotlines. The important thing is you talk to someone and get the help you need. You are worth it!

If you are a general healthcare practioner reading this, here are some helpful tips to guide you in diagnosing eating disorders in your patients:

  1. Listen to your patient
  2. Observe your patient's physical appearance, state of mind, and attitudes
  3. Ask questions to your patients, whose feedback will provide you indicators about their behaviors and attitudes on food, weight, and body image
  4. Analyze lab results for indications of eating disorder symptoms
  5. Review medical history of the patient for information about past medical problems and family medical history
  6. Provide referrals to eating disorder specialists for a comprehensive evaluation, if you suspect a patient has an eating disorder

Many patients with eating disorders have additional psychiatric comorbities or disorders, including depression, anxiety (both generalized and social anxiety), affective disorder, obsessive-compulsive disorder, somatization disorder, and substance abuse.

While certain symptoms may be indicative of an eating disorder, it is necessary to rule out other conditions that lead to weight loss and problematic eating behaviors, such as with inflammatory bowel disease and hyperthyroidism.
 
The major qualifying difference between a person with an eating disorder and a person with a medical condition contributing to weight loss is that the person with the eating disorder desires extreme thinness and does not want to gain weight, while a person with a medical condition leading to weight loss expresses concern at being underweight and desires to obtain a healthier weight.

The diagnostic criteria for anorexia nervosa and bulimia nervosa are listed separately in the Diagnostic and Statistical Manual of Mental Disorders (rev. 4th ed., 2000).  However, they appear very similar.       

Both the anorexia nervosa and bulimia nervosa diagnoses have four common features, which distinguish them as eating disorders.  The individual:
  1. Has an intense fear of gaining weight
  2. Has a self-critical evaluation of his physical appearance
  3. Bases his self-worth solely on his perceived success to manage weight 
  4. Uses compensatory measures to manage weight through restrictive food intake, excessive exercising, and/or purging (- self-induced vomiting, and abusing laxatives and diuretics)   
The differences between the diagnosis of anorexia and bulimia are essentially that:
  1. The person with anorexia maintains a severely low body weight at or below 85% of expected body mass for age and height, while the bulimic typically has a body weight more in the normal range 
  2. The anorexic does not perceive himself as underweight, denies the health risks of being underweight, and is unwilling to gain weight to a healthy level 
  3. The low weight of the anorexic female results in amenorrhea, the stoppage of menstruation
For an excellent resource of information on the subject of diagnosis of eating disorders, go to the American Academy of Family Physicians (AAFP) website at: http://www.aafp.org/afp/20030115/297.html for their article posted from the American Family Physician, a peer-oriented journal of AAFP with article title "Diagnosis of Eating Disorders in Primary Care" by Sarah D. Pritts and Jeffrey Susman.  
 
Eating Disorders in Males Often Go Undetected
   
Eating disorders in males often are either undiagnosed or misdiagnosed by medical professionals, and therefore, are under-reported.  The reasons for not recognizing an eating disorder in a male include:  

·        The patient denies any problem with food and eating

·        The patient presents convincing, rational, health conscious reasons for compulsive exercising and a rigid diet, such as to maintain optimum health and prevent disease

·        Medical professionals are not well informed on the symptoms, diagnostic criteria, and treatment options for eating disorders

·        Physicians do not know how to tactfully approach asking their patients if they have an eating disorder   

 

Males are too embarrassed to admit to their eating disorder or are oblivious to the context of their problems.  To make matters worse, many physicians only suspect an eating disorder as a last resort, if at all.  There is a great deal of secrecy surrounding eating disorders, especially for men, much the same way HIV is a very covert subject. 

 
Diagnostic Flaw 
 
One of the criteria in determining an eating disorder according to the Diagnostic and Statistical Manual of Mental Disorders is the absence of amenorrhea.  Such a standard presumes males are immune from eating disorders, but they are not immune.  If this is held up as a criteria in diagnosing eating disorders, then there should be a corresponding criteria for diagnosing males with this illness. 
 
Low levels of testosterone correlate with a diminished or absent sex drive.  A reduction in gonadotropin secretion in anorexic males may be a corresponding feature to amenorrhea (Herzog et al., 1990; Burge, Lanzi, Skarda & Eaton, 1997). 
 
The endocrinological disturbances caused by the disordered eating and weight loss result in low testosterone output.  Testosterone levels in males will normalize with weight gain and stabilization of dietary patterns (Herzog, D.B.; Bradburn, I. S. & Newman, K., 1990). 
 
While, this could be a potential criteria to use for males who are significantly underweight, it would not be useful as a tool in determining eating disorders in males who are not significantly below weight.  A blood sample can be taken to measure testosterone level. 
 
Regardless of whatever physiological indicators of whatever reliability there may be for diagnosing an eating disorder, any diagnostic criteria should primarily rest upon the patient’s psychological state of mind and his attitudes, beliefs, and behaviors toward food, weight, and exercise.  
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Burge, M. R.; Lanzi, R. A.; Skarda, S. T. & Eaton, R. P. (1997) “Idiopathic Hypogonadotropic Hypogonadism in a Male Runner is Reversed by Clomiphene Citrate” in Fertility and Sterility, 67, pp. 783-785.
 
Diagnostic and Statistical Manual of Mental Disorders, 4th rev. ed.  (Washington, D.C.: American Psychiatric Association, 2000) pp. 589, 594. 
 
Herzog, D. B.; Bradburn, I. S. & Newman, K. (1990)  "Sexuality in Males with Eating Disorders" in Males with Eating Disorders by ed. A. E. Andersen (New York: Brunner/Mazel, 1990) pp. 40-53.

 
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