How do you tell if someone has an eating disorder?



And if I think they do have an eating disorder, what do I do about it?

When you think your client may be at risk of an eating disorder, it is helpful to review the diagnostic criteria for the eating disorders.  Professionals refer this list of criteria to determine whether their client may have an eating disorder, such as anorexia, bulimia, or binge eating disorder. 

Think about your client’s clinical findings and risk factors as you review the criteria for each eating disorder.  Ask yourself the following questions to decide the best course of action: 


Ask Yourself:

Take appropriate action:

Do all of the criteria fit with your client’s profile?

Refer immediately to a mental health professional.  It is in your client’s best interest to seek psychological counseling. As long as their eating disorder monopolizes their life, anything you try to teach them about nutrition will be useless.  They first need to address the psychological issues they face with help from a mental health professional.

Do most but not all of the criteria fit with your client’s profile?

If your client meets several of the criteria listed for a particular eating disorder, you need to make a judgment call about whether it is appropriate to refer your client to a mental health professional.  If your client meets 75% of the diagnostic criteria for an eating disorder, it is probably a good idea to refer him/her to a mental health professional.

Do just a few of the criteria fit with your client’s profile?

If your client only meets less than half of the criteria listed for a particular eating disorder, it may be more appropriate to wait before referring him/her to a mental health professional.  In this case, you should talk to the client about your concerns and closely monitor your client’s behavior.  You should let your client know what behaviors concern you, what changes you want him/her to make, and what kind of specific progress you will be looking for on follow up visits.

It is effective to give clients very specific guidelines.  For example, you could say “I expect you to gain 2 pounds by your appointment next week, and to keep your food journal for 5 of the 7 days. If you do not, you will need to see a social worker or psychologist for further help. Is that understood?” You may even create an agreement or “contract” that indicates the goals and expectations for your client to sign.

It can be difficult at times to determine whether a client has an eating disorder. If you feel uncomfortable treating your client, that may be a sign that the client may have issues that fall outside your area of expertise and a referral for psychological counseling may be appropriate.

Another way to determine whether a referral is appropriate is to give the client a challenge to meet.  That can be a good way to help you make a decision about how serious the situation is and whether a referral is needed. You ask the client to agree to meet certain goals. If these goals are not met, then further help will be recommended.

Remember that it is okay to tell client you have concerns about his/her eating habits or weight pattern and that you are willing to work with them as long as you see progress. However, the first sign that the client is not progressing toward the goal a referral to a mental health professional.  When you are in doubt about whether such a referral is appropriate, it is a good idea to err on the side of caution.

If someone has multiple risk factors or symptoms of an eating disorder, does that mean that they necessarily have an eating disorder?

A client who exhibits more than one risk factor or clinical finding for an eating disorder may or may not have an eating disorder.  It can be difficult to make this assessment, which is why professionals use tools like the diagnostic criteria for the eating disorders to help them make the right call. 

If your client does show signs that match the diagnostic criteria, refer to the table above to interpret the criteria and what you should do for your client.

If the risk factors and clinical findings that your client has do not match any of those included in the diagnostic criteria, that does not necessarily mean your client is in the clear. You should monitor your client closely, set goals that both of you agree upon, and make a plan if the goals are not met. As a practitioner you need to follow through with your plan. Do not let your client manipulate your good judgment. It’s never wrong to make a recommendation to a psychological counselor to get another opinion. Professionals who work with patients with eating disorders may have more experience in diagnosing a problem and with creating an appropriate treatment plan.