Recently, I wrote about gluten sensitivity as a “cover” for an eating disorder. But that begs the question: How does one diagnose an eating disorder?

While the health care profession in this country acts as warmonger in the ongoing battle against obesity, it is important to not forget that about one-half of adult Americans already are on a diet on any given day. Unfortunately, according to the National Eating Disorders Association, approximately one-quarter of these adults will develop some degree of eating disorder.

The physical appearance and complaints of someone with an eating disorder will vary, depending on the severity. It is not unusual for patients with anorexia or bulimia to suffer dizziness, headache, fatigue, abdominal pain, constipation, menstrual irregularities, and cold intolerance. Physical examination might show muscle wasting and weakness.

However, it is quite difficult to diagnose eating disorders, particularly when one considers that many patients shift between binge eating and anorexia.

One answer to this diagnostic dilemma is actually a series of questions, developed by British researchers over a decade ago, and known as the SCOFF Questionnaire. To use this diagnostic tool, score one point for each “yes;” a score of 2 or more indicates a likely case of anorexia nervosa or bulimia. Below are the five questions:

1. Do you make yourself Sick because you feel uncomfortably full?

2. Do you worry you have lost Control over how much you eat?

3. Have you recently lost more than One stone (14 pounds) in a 3-month period?

4. Do you believe yourself to be Fat when others say you are too thin?

5. Would you say that Food dominates your life?

The risks for developing an eating disorder are protean and pervasive. Groups at risk include adolescents with chronic illness, patients with a family history of eating disorders, obese patients who have chronically failed at weight loss—including those who have had wide fluctuations in their weight, and elite athletes. Pre-existing psychiatric disorders also increase the risk: Depression, anxiety, and obsessive-compulsive conditions all can serve as fertile ground for the growth of an eating disorder.

Medical and psychological health care providers need to cooperate in the diagnosis and treatment of eating disorder patients. Of course, when considering therapy, the patient must first be medically stabilized, through nutritional interventions and medications if necessary (although for anorexics there does not appear to be very effective medications). Next, comes the psychological intervention, the talking and the listening.

But the talking and the listening should really be ongoing for all patients, as this is the best way to diagnose the eating disorder in the first place. Anorexics in particular may be evasive when answering questions about their health, as they appear most threatened by the discovery of the condition. It is for this reason that health care workers who suspect an eating disorder should be persistent, and take the few minutes to use tools such as the SCOFF questionnaire.

Ultimately, the patient whose secret is revealed may be the patient most grateful.

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