Academic journal article Journal of Eating Disorders

Assessment of Anorexia Nervosa: An Overview of Universal Issues and Contextual Challenges

Academic journal article Journal of Eating Disorders

Assessment of Anorexia Nervosa: An Overview of Universal Issues and Contextual Challenges

Article excerpt

Author(s): Lois J Surgenor[sup.1] and Sarah Maguire[sup.2]


Most health workers recognise that anorexia nervosa (AN) is a serious disorder that results in significant disability and impaired quality of life. Unfortunately for some, this disorder becomes a chronic or life-shortening illness. It is well-established that AN has the highest mortality rate of all psychiatric disorders [1]; compared with their peers without the illness the risk of premature death is approximately ten-fold in a person with AN [2]. Health consequences are widespread, both in terms of direct physical and mental health effects and economic costs to society overall; a recent Australian analysis placed the total yearly direct health system costs of AN at $59.8 million [3]. This means that although AN and AN-like conditions are relatively rare, severe and enduring forms of AN have impairment outcomes comparable to people with moderately severe depression and schizophrenia [3].

Assessment and a resulting early diagnosis become a vital task for the health system and current research continues to suggest that, although primary care is the context of most presentation [4] areas with specialist services have more than double the number of diagnosable eating disorder (ED) cases, suggesting a sizeable proportion of diagnoses do not occur until the specialist service level [5]. What this means for both settings is worth discussion, but regardless, assessment skills and knowledge of the evidence base pertaining to diagnoses remain an important part of the skill set of the specialist clinician.

Regardless of the setting and complexity, there are descriptions of 'ideal practice' in the assessment of the disorder and associated health difficulties. However, assessment approaches do vary, along with models of service delivery, admission thresholds and the resources available in specialist settings [5]. Such factors will influence the composition of a multidisciplinary assessment team. There are suggestions about what constitutes an 'ideal' assessment team, but rarely will services have all recommended components, and multiple tasks may fall to 'mini teams' [6]. There is however areas of general consensus about many necessary and desirable tasks of assessment and given the above constraints it often falls to the specialist clinician working in relative isolation to be well versed in all factors pertinent to a comprehensive assessment. Focusing primarily on adult populations, this paper aims to reduce the gap between research and practice (as it relates to assessment of AN) by firstly providing a comprehensive review of the current literature relating to assessment pathways, barriers to assessment, diagnostic issues, instruments for assessment of illness and severity, role of the family at assessment, comorbid presentations relevant to assessment, medical, nutritional and compulsory assessment practises. Secondly, it discusses the process of synthesising information gathered at assessment for the purposes of formulation and ultimately to direct treatment.

Pathways to assessment

Links with primary care providers

Given the scarcity of specialist ED services, most people with AN will not be seen by a specialist service in the first instance, and for a significant number, specialist assessment may not occur at any stage. Half of those with an ED are first diagnosed by their primary care physician, although of concern a sizeable minority may go through life without any help whether this is for AN or other emotional problems [4]. General practitioners (GPs) and other primary health care providers are best placed to be the health practitioners first involved in conducting preliminary assessments, providing initial triage, and thereafter sharing case management with other clinicians [7]. This is partly because people with eating disorders attend GPs and other medical speciality services more frequently than their peer group, albeit often for conditions seemingly unrelated to the disorder. …

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