From the Guidelines
To assess anxiety in an inpatient eating disorder program, use a multi-method approach combining standardized assessment tools, clinical interviews, and behavioral observations, as recommended by the American Psychiatric Association 1. Begin with validated anxiety measures such as the Beck Anxiety Inventory (BAI), State-Trait Anxiety Inventory (STAI), or the Generalized Anxiety Disorder 7-item scale (GAD-7), which provide quantifiable data on anxiety symptoms. Conduct thorough clinical interviews focusing on anxiety manifestations specific to eating disorders, such as mealtime anxiety, body image concerns, and fear of weight gain. Daily monitoring should include vital signs (heart rate, blood pressure), as physiological indicators of anxiety often accompany eating disorders. Observe behavioral markers like meal avoidance, ritualistic behaviors, sleep disturbances, and social withdrawal. Implement regular check-ins using subjective units of distress scales (SUDS) to track anxiety fluctuations, particularly around challenging situations like meals or weigh-ins. This comprehensive assessment approach is essential because anxiety often intertwines with eating disorder pathology, potentially hindering treatment progress if not properly addressed, as noted in the American Psychiatric Association practice guidelines 1. The information gathered helps tailor interventions to each patient's specific anxiety profile while monitoring treatment effectiveness throughout the inpatient stay. Some key points to consider in the assessment include:
- Presence of co-occurring health conditions, including co-occurring psychiatric disorders 1
- Comprehensive review of systems 1
- Initial physical examination, including assessment of vital signs and physical appearance 1
- Laboratory assessment, including a complete blood count and comprehensive metabolic panel 1
- Electrocardiogram for patients with restrictive eating disorder, severe purging behavior, or taking medications that prolong QTc intervals 1. By following these guidelines and using a multi-method approach, clinicians can effectively assess anxiety in patients with eating disorders and develop personalized treatment plans to address their unique needs.
From the Research
Assessing Anxiety in Inpatient Eating Disorder Programs
To assess anxiety in inpatients with eating disorders, several tools and strategies can be employed. The following points highlight some key considerations and instruments:
- Generalized Anxiety Disorder 7-item (GAD-7) and 2-item (GAD-2) scales: These are widely used instruments for detecting anxiety disorders in adults 2. The GAD-7 has a summary sensitivity of 0.64 and a summary specificity of 0.91 for detecting generalized anxiety disorder, while the GAD-2 has a summary sensitivity of 0.68 and a summary specificity of 0.86 2.
- Assessment of eating disorders: A thorough assessment of eating disorders should cover critical domains, including psychological, physical, and behavioral aspects 3, 4. Well-validated, standardized assessment instruments are essential for justifying treatment plans and providing objective data on client progress and outcome 3.
- Psychometrically sound assessment instruments: Several psychometrically validated assessments are available for adults with eating disorders, including interviews and self-report questionnaires 4. These instruments can help clinicians and researchers make informed decisions about assessment and treatment.
- Clinical context: The assessment of anxiety in inpatients with eating disorders should consider the clinical context, including the patient's medical and psychiatric history, current symptoms, and treatment goals 5, 6. Primary care providers can play a crucial role in early recognition and diagnosis of mental health disorders, including anxiety, using tools like the GAD-2 and GAD-7 6.
Key Considerations
When assessing anxiety in inpatients with eating disorders, consider the following:
- Comorbidities: Many patients with eating disorders also experience anxiety disorders, so it's essential to assess for comorbidities 5.
- Treatment planning: Assessment results should inform treatment planning, including the use of antidepressants or other therapies 5.
- Patient engagement: Building trust and rapport with patients is critical for effective assessment and treatment 6.