Clinical Assessment of Patients
with Eating Disorders
ROBERT L. PALMER
The assessment of an adult presenting with a probable eating disorder involves the coming together of a clinician and a sufferer in pursuit of several ends. These include the clinician’s attempts to make an adequate description and diagnosis of the clinical state of the patient, to achieve some understanding of the patient’s experience, to decide what may be offered to the patient, and to start to establish a working relationship with the patient. Pursuit of the last end will inevitably involve a further process. The sufferer will be making a parallel assessment of the assessor. Does the clinician seem competent, understanding, and trustworthy? Or not? Each of these aspects of assessment is discussed separately, although in practice they all occur together. The style of the encounter will depend to an extent upon the setting and the background of those involved, but, ideally, it will take place within a conversation that feels authentic and fairly comfortable for both parties.
All patients also require some assessment of their physical state. (See Chapter 50 for a discussion of the medical complications of anorexia nervosa and bulimia nervosa.) It goes without saying that the assessment of an anorexia nervosa sufferer at very low weight or someone with exceptionally severe bulimia nervosa will require more attention to the physical than would be the case with less precarious disorders. Likewise, some such cases may demand more urgent intervention. However, this chapter concentrates upon the general issues involved in assessing a typical adult patient.
The patient will characteristically have mixed feelings. She—or sometimes he (see Chapter 33 for a discussion of eating disorders in men)—may want help but will often be wary about what it may involve. Typically, the anorexia nervosa sufferer will fear losing the