What are the most important assessments, including surveys like the Eating Disorder Inventory (EDI) and the Eating Attitudes Test (EAT), for a 14-year-old presenting with concerns of an eating disorder?

Essential Surveys and Assessments for a 14-Year-Old with Eating Disorder Concerns

The most important assessments for a 14-year-old presenting with eating disorder concerns include the Eating Attitudes Test (EAT-26), Eating Disorder Examination (EDE) interview, and a comprehensive clinical evaluation that assesses weight history, eating behaviors, compensatory behaviors, and psychological factors.

Initial Screening and Assessment Tools

• Eating Attitudes Test (EAT-26): A validated self-report questionnaire that identifies individuals at risk for eating disorders, with scores ≥20 indicating increased risk 1
• Eating Disorder Examination (EDE): A semi-structured interview considered the gold standard for assessing eating disorder diagnoses and symptomatology, which can be modified for use with adolescents 2, 3
• Eating Disorder Inventory (EDI): Assesses behavioral and psychological traits associated with eating disorders; a very short form (EDI-VS) is available for more efficient screening 4

Critical Clinical Assessment Components

Weight and Eating History Assessment

• Document complete height and weight history, including maximum and minimum weight, recent weight changes, and growth trajectory 5
• Plot current height, weight, and BMI on growth charts to identify concerning patterns (BMI below 5th percentile or rapid BMI decline may indicate an eating disorder) 5
• Assess for high-risk eating behaviors including severe dietary restriction, meal skipping, prolonged starvation periods, and binge eating 5

Eating Behavior Assessment

• Evaluate patterns and changes in restrictive eating, food avoidance, and binge eating behaviors 5
• Quantify frequency, intensity, and time spent on dietary restriction, binge eating, and other eating-related behaviors 5
• Assess changes in food repertoire, including narrowing or elimination of food groups 5

Compensatory Behaviors Assessment

• Document presence, patterns, and changes in compensatory behaviors including:
  • Self-induced vomiting
  • Laxative, diet pill, or diuretic use
  • Compulsive or driven exercise
  • Other weight control behaviors 5

Psychological Assessment

• Evaluate percentage of time preoccupied with food, weight, and body shape 5
• Assess for body image distortion, fear of weight gain, and overvalued ideas about weight and shape 5
• Screen for low self-esteem, which significantly correlates with positive eating disorder screening (OR = 46.67) 1
• Evaluate family relationships, as contentious relationships with parents correlate with positive eating disorder screening 1

Physical Examination and Medical Assessment

• Vital signs assessment: temperature, resting heart rate, blood pressure, orthostatic pulse, and orthostatic blood pressure 5
• Physical examination for signs of malnutrition or purging behaviors 5
• Laboratory assessment including complete blood count and comprehensive metabolic panel 5
• Electrocardiogram for patients with restrictive eating disorders or severe purging behaviors 5

Family-Based Assessment

• Evaluate family meal patterns, as family meals can be protective against disordered eating behaviors 5
• Assess for family weight talk and weight-based teasing, which are risk factors for eating disorders 5, 6
• Evaluate dieting behaviors within the family, as dieting is a significant predictor of developing an eating disorder 5

Co-occurring Conditions Assessment

• Screen for co-occurring psychiatric disorders, which are common in eating disorders 5
• Assess for family history of eating disorders, other psychiatric illnesses, and relevant medical conditions 5

Clinical Pitfalls to Avoid

• Denial and concealment: Adolescents with eating disorders often minimize or hide symptoms, making collateral information from parents crucial 7
• Focusing only on weight: Eating disorders can occur at any weight; normal-weight adolescents may engage in disordered eating behaviors 5
• Overlooking family dynamics: Contentious family relationships and family weight talk significantly impact eating disorder risk 1
• Neglecting developmental considerations: Adolescents may have difficulty articulating complex concepts related to body image and eating behaviors, requiring age-appropriate assessment approaches 3

By implementing this comprehensive assessment approach, clinicians can effectively identify eating disorders in adolescents and develop appropriate treatment plans that address both medical and psychological aspects of these serious conditions.