The Power of An Accurate Eating Disorder Diagnosis
Diagnosis is a powerful tool and is the first step in developing and monitoring an effective treatment plan for eating disorders and mood, anxiety and trauma-related disorders. “The initial diagnosis can help patients focus on what is happening to them, what may be contributing to the problem and what can be done about it,” says Ellen Astrachan-Fletcher, PhD, FAED, CEDS-S (she/her/hers), regional clinical director at Eating Recovery Center and Pathlight Mood & Anxiety Center (ERC Pathlight). “The diagnosis is an important part of the process, and sometimes I don’t think we give it the attention it deserves, including for co-occurring conditions.”
Eating Disorder Diagnosis: The Intake
To ensure that each patient’s diagnosis is as accurate as possible, ERC Pathlight has a multistep diagnostic process. It begins with a comprehensive assessment conducted by a master’s-level clinician before the patient is admitted. “Our intake assessment is important for providing level-of-care recommendations to guide patients into the most appropriate program,” says Rebecca Linehan (she/her/hers), director of admissions at ERC Pathlight. “It sets the course of their treatment and recovery.”
“Our transdiagnostic care approach includes a comprehensive assessment that enables us to identify symptoms and behaviors that may have been previously overlooked, allowing us to treat the whole person effectively,” says Kim Anderson, PhD, CEDS (she/her/hers), executive director at ERC Pathlight.
Eating Disorder Diagnosis: Meeting the Treatment Team
Following admission, ERC Pathlight’s multidisciplinary team, including a primary care physician, psychiatrist, therapist and dietitian (for our eating disorder patients), performs extensive psychiatric, medical and psychosocial evaluations. Their goal is to identify the primary and co-occurring conditions, such as obsessive-compulsive disorder (OCD) or substance use disorders.
The benefit of ERC Pathlight’s approach is that the team never stops collecting and evaluating new information as it becomes available. For example, Dr. Anderson recalls a patient diagnosed with avoidant restrictive food intake disorder (ARFID). For the first few weeks of treatment, the focus was on increasing food intake and volume through family-based treatment and exposure therapy. In particular, the exposure therapy addressed the sensory sensitivities the patient associated with food and the accompanying feelings of disgust about certain food textures. The treatment was successful in that she started gaining weight. “But then, this patient started expressing concerns about how the weight gain was making her feel uncomfortable in her body,” says Dr. Anderson. “At that point, the diagnosis shifted to anorexia, and we started doing body image work. She responded very well.
“The important message here is that the team noticed the change and modified treatment accordingly,” adds Dr. Anderson. “In this way, both diagnosis and treatment continue to evolve.”
Meeting Patients Where They Are
Clinicians should be prepared to validate and hold space for a wide range of reactions when
they share any diagnosis with patients and their families. “Some people will feel relieved that they have an illness that has a name and can be treated,” says Dr. Anderson. “Others may feel shocked and scared, overwhelmed by what the diagnosis will mean for their lives, or have trouble accepting it. Those people should be continuously reassured to not blame themselves or feel guilt and shame because of the diagnosis.” They can also be given education that helps them overcome the stigma they may associate with their diagnosis. This process isn’t a “one and done” discussion but an ongoing part of treatment.
Diagnosis is an integral part of the healing process. It opens the door to effective, appropriate treatment. Importantly, it’s also a turning point for many patients. “Many patients have said that following the diagnosis, they felt understood,” says Dr. Astrachan-Fletcher. “That’s a powerful way to begin therapy.”
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Please contact us to make a referral or schedule a free consultation with a master’s-level clinician at 1-877-825-8584.
This article first appeared in Luminary, A Magazine for Mental Health Professionals. Find more articles for additional tips, resources and insights from leading experts in the field.