Eating Disorders: What Can PAs Do?
Eating disorders are among the most common psychiatric disorders in young women. Early detection and treatment improve the prognosis, but the presentation of eating disorders can be difficult to catch.
In the US, 9% of the population, about 28.8 million Americans, will have an eating disorder in their lifetime. Eating disorders are more common in women with the overall lifetime prevalence estimated to be about 8.60% among females and 4.07% among males.
Eating disorders are characterized by a persistent disturbance of eating behavior that impairs a person’s health or psychosocial functioning. Diagnostic criteria divide eating disorders into categories based upon observed symptoms, including anorexia nervosa, avoidant/restrictive food intake disorder, binge eating disorder, bulimia nervosa, pica, and rumination disorder.
The causes of eating disorders are multifactorial and include a combination of biological, sociocultural, and psychological factors. Likewise, risk factors for eating disorders can be nonspecific and associated with risk for psychiatric illness, or specific to eating disorders. For example, individuals who engage in high-risk sports, hobbies, or careers such as wrestlers, dancers, models, and actors may be at increased risk for eating disorders. Social media may also influence one’s desire to be thin and perceptions about the same.
Screening is important. Clinicians can screen for eating disorders by asking the patient or family members whether they have any concerns about the patient’s weight, body shape, body image, or eating behaviors.
If screening is implemented, the SCOFF questionnaire should be performed. The SCOFF consists of five clinician-administered questions:
- Do you make yourself Sick because you feel uncomfortably full?
- Do you worry you have lost Control over how much you eat?
- Have you recently lost more than One stone (14 pounds or 6.35 kg) in a three-month period?
- Do you believe yourself to be Fat when others say you are too thin?
- Would you say that Food dominates your life?
Answering “yes” to two or more questions is generally regarded as a positive screen, and a positive screen warrants further assessment to establish or rule out a diagnosis.
For Board Certified PAs, taking a comprehensive history and being attentive to concerns that your patients or their family may express are essential. When an eating disorder is suspected, PAs can conduct a screening and, when needed, connect patients and families to additional care or resources.
Resources & References:
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), 2022.
- Guarda, A. (2023). Eating disorders: Overview of epidemiology, clinical features, and diagnosis. In J. Yager (Ed.), UpToDate. Eating disorders: Overview of epidemiology, clinical features, and diagnosis – UpToDate
- Morgan JF, Reid F, Lacey JH. The SCOFF questionnaire: a new screening tool for eating disorders. West J Med. 2000 Mar;172(3):164-5. doi: 10.1136/ewjm.172.3.164. PMID: 18751246; PMCID: PMC1070794.
- National Eating Disorder Association: https://www.nationaleatingdisorders.org/