Eating Disorders Early Diagnosing- Screening Methods and Risk Groups for Screening

by Dr. Elisaveta Pavlova, PhD, CEDS, MS, IE-Pro, EDIT-I, iaedp™ Board Member & International Chapter Chair


Eating disorders(ED) are significant bio-psychosocial diseases with increasing prevalence among all ages, ethnic groups, social strata of society and among both sexes.

Comprehensiveness of the problem, the high percentage of lethality, and number of physiological, psychological and social consequences from these disorders create the need to draw up programs, to promote a healthy life and an active prevention including early detection and timely interventions for eating disorders .

All eating disorders lead to serious physical and psychological consequences. Besides life-threatening weight loss in anorexia nervosa, other physiological consequences of eating disorders also can be serious or life-threatening, such as electrolyte imbalance or cardiac arrest, which stem from unhealthy compensatory mechanisms (or called purging behaviors such as vomiting, compulsive exercising, periods of fasting, regular use of laxatives, diuretics, laxatives, enemas, etc.) in bulimia nervosa, restrictive or purge sub-type anorexia nervosa. Even if they have not met all the diagnostic criteria for an eating disorde,r pathology associated with eating disorders (eg, frequent vomiting, excessive exercise, anxiety) can often have long-term implications and require professional intervention. Early detection of ED can prevent progression to full “bloom” of clinical eating disorder.

According to unofficial statistics, as there is no athoer at the moment, the sick in Bulgaria only from anorexia nervosa and bulimia nervosa are at least 300,000, and this figure does not include the third clinical diagnosis of ED- bing eating, and 4th and 5th groups of eating disorders, which were officially recognized as  separate categories in the DSM-5 in May 2013 (APA 2013). Data from a National survey in Bulgaria in the period 2010/2011. reported that 20% of girls and 8% of boys aged between 10-19 years are at risk of developing some type of eating disorder (Duleva, 2012). Another national survey conducted in 1998-2004 period indicates that young women 19 to 29 years found among those there is significant prevalence of underweight with increasing tendency(Petrova and Associates, 2012).

There is serious comorbidity of eating disorders with certain psychiatric disorders such as depression, obsessive compulsive disorder (OCD), bipolar disorder, personality disorders, and others. Moreover, quite a few of these people have addictions to alcohol and psychoactive substances.

Many people with eating disorders have symptoms of depressive circle. There is no doubt that depression is associated with eating disorders. It is due to the serious effects on health of this comorbidity between eating disorders and depression that the Beck depression questionnaire is included in this tudy.

Reasons (factors) for the occurrence of eating disorders; comorbidity and depression

Modern trends in studyng these problems believe that the etiology of eating disorders and their symptoms would be best characterized by multifactorial models incorporating – biological, psychological, interpersonal and cultural factors.

The inclusion of biological, psychological and social factors in the model of eating disorders indicates the inability to determine a specific reason as a risk for their development. We can not look for the “cause” for ED related, for example, a personal history or trauma and even interaction between psychological processes of groups of factors (Gilbert P, 2002).

Research has identified many groups of risk factors, ranging from individual to family and socio-cultural that contribute to the development of eating disorders, which on the basis of the empirical literature generally, can be reduced to the presented below (Blodgett S, 2015): Individual factors: Genetic predisposition, Neurobiological factors, Negative body image, Compliance with the diet, Psychological and emotional problems, Negative affectivity, Weight gain during puberty, The timing of puberty, Personality traits, Sotsiokulturalni factors: Internalization of the ” Thin ideal”, Media, The impact of peers, and Family factors.

Thus, prevention of eating disorders and its subclinical forms of ED is compelling due to their complexity, and the difficulty for long-term treatment with remission in about half of those affected, as well as the low % of demand for professional intervention, which is mandatory for successful healing of the sick, prevent ion of its chronicity, poor quality of life and lower % lethality.

Early detection, the initial assessment and ongoing management play a significant role in the recovery and prevention of eating disorder to become more severe or chronic conditions (Stice E, Shaw H, Marty C, 2004).

  1. Identification of risk groups for ED screening

Early intervention depends on early detection of symptoms. The long delay before seeking treatment for eating disorders are related to destored health and decreased quality of life in long run.

Observed is a median delay of about 4 years, which can reach even up to 10 years and more before the initial ED symptoms and the act of seeking professional help for those deseases. Shortening this period of delay before professional treatment would significantly increase the quality of life and would significantly improve the health and protect the patients from ED chronicity and there lasting life-threatening consequences.

Most people with ED do not speak specifically about there destored eating thougts or behaviours with healthcare professionals, with whom they usually have a connection. Due to the lack of visible unrelated complaints of patients to their private doctor and other medical professionals who interact with many individuals, most of the ED sufarars remaine undiagnosed. The most common health complaints such individuals present to medical professionals includes emotional problems, weight loss and gastrointestinal problems.

Research shows that the most common contacted place for eating disorders are primarily GPs and school counsellors. Individuals engaged in sport may seek physiotherapist about their injuries. Adults with eating disorders can seek professional help to treat  their infertility, some statistics show that 30% of the patients at the “In vitro clinics” are affected by some form of disordered eating (Evans et al., 2011).

  1. Screening questions

Screening is a systematic research method in the field of medicine, aimed at carrying out a preliminary selection by general classification to a preselected area of ​​study (samples or personalities). The pre-selection or stratification of the sample used for the recruitment of subjects who are carriers of certain signs and later will be subject to special examination.

Screening questions help people with ED talking about the disapproval of their own bodies or their distorted eating with health professionals, which could facilitate access to treatment.

Screening is important for the evaluation of ED because:

  • Eating disorders are complex syndromes with serious effects on health and quality of life.
  • Early detection and intervention of ED can reduce the severity of the effects of these diseases.
  • High risk groups can be identified.
  • There are screening tests.

In this case, our efforts are geared towards the development and validation of Bulgarian terms of battery for early detection of symptoms of ED.

Screening can be in the form of even five points, as an example of the questionnaire is that of SCOFF (which we also include in the battery of our study). Screening tests, like the mentioned already, do not diagnose eating disorders, but to identify the possible presence of distorted eating and ensure targeting such by thorough professional diagnosis for eating disorders (Luck et al., 2002).

  1. Screening for high-risk groups
  • Boys and girls in puberty and teenage
  • Women during transitional periods in their lives
  • Women with polycystic ovary syndrome or diabetes
  • Athletes and individuals involved in competitive and stage performing activity
  • Individuals with a family history of eating disorder
  • Persons seeking help with weight loss
  1. Screening tools for EDs

Tools for screening are insufficient to build a diagnosis of ED but are useful tools for rapid initial screenings designed to detect suspicious symptoms on the first stage of the two stage screening process, where those that show higher numerical results will be evaluated again with clinical interview for establishing formal diagnosis of ED.

For identification of cases of ED, have been developed several screening methods for self-evaluation that allow systematic tracking.

Each of these screening tools include questions about individual nutritional and dietary habits, weight, exercise, menstruation, body image, self-esteem, use of substances, relationships with family and many others. It is therefore of great importance for patients with ED visiting their doctor to be asked this kind of questions, as most affected complained of other symptoms such as weight loss, amenorrhea, depression and irritability.

  1. Useful tools for identifying cases of ED

As a result of thorough examination of the literature on the subject of all the proposed criteria and recommendations for screening tools, some authors offer: relevance, development, psychometric properties and external validity to be the most important once. Taking this into account and based on the results of SRSE published by Jacobi et al. (2004) only four screening tool could identify cases of ED and these are: BET (Branched Eating Disorders Test) EDDS (Eating Disorder Diagnostic Scale), SED (Survey for Eating Disorders) and SCOFF (Sick, Control, One, Fat, Food questionnaire).

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