Eating Disorder Psychopathology
DAVID M. GARNER
The general clinical features and psychopathology associated with anorexia nervosa and bulimia nervosa are well documented and widely accepted (see Chapter 29). Less is known about psychopathology associated with binge eating disorder and other eating disorders. While there is no universally accepted assessment protocol for eating disorders, there is a consensus on the value of utilizing different assessment methods to tap the broad range of associated symptoms and traits.
The targets for assessment of patients with eating disorders can be divided into two main areas: (1) psychological features and behavioral patterns that define the core features of eating disorders (“specific psychopathology”), and (2) psychopathology, not specific to patients with eating disorders, but that has particular theoretical or clinical relevance (“general psychopathology”).
The patient’s current body weight and weight history provide essential diagnostic information and allow the clinician to explore the meaning that body weight and shape has for the patient. Since amenorrhea is required to make the diagnosis of anorexia nervosa (see Chapter 28), the clinician should determine the patient’s menstrual history within the context of the weight history.
In the case of anorexia nervosa, it is usually advisable for the clinician to weigh the patient as part of the clinical interview. This should be done in a sensitive but straightforward manner, emphasizing physical and psychological implications of changes in body weight. However, even if body weight is not dangerously low, weight changes are critical