How do you tell if someone has an
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
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:
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
Do most but not all of the criteria fit with your
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
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