Screeners for Eating Disorders

There are several screening tools useful for detecting disordered eating behaviors in patients. These tools are not designed to make a diagnosis; however, they can be helpful in identifying those who could benefit from a referral to a specialist for an eating disorder evaluation. Patients may not always bring up these issues on their own, so it is important to ask specific questions about this subject. The National Eating Disorder Association (NEDA) recommends asking patients about: History of weight fluctuations Actions taken to maintain, control, or alter weight Dieting Laxatives, enemas, diuretics, appetite suppressants, supplements Vomiting Excessive exercise Periods of binge eating or feeling a lack of control over food intake Comfort with current weight/shape Report of typical daily food and water intake Exercise habits (How much? How often? Why?) Menstrual history Family history of eating disorders, depression, obesity, and chemical obedience Below are three examples of eating disorder screeners that healthcare providers can incorporate into your practice. SCOFF Questionnaire Five question screener, with sensitivity of 100% and specificity of 90% for anorexia nervosa Do you make yourself Sick because you feel uncomfortably full? Do you worry that you have lost Control over how much you eat? Have you recently lost more than One stone (14lbs) in a 3-month period? Do you believe yourself to be Fat when others say you are too thin? Would you say that Food dominates your life? Eating Attitudes Test (EAT-26) Screener divided into Part A, B, and C designed to measure symptoms characteristic of eating disorders If patient is underweight, scored 20 or more on Part B, or marked specific boxes in Part... read more

Health at Every Size

Patients seeking medical care are typically first evaluated on the basis of their weight, regardless of whether or not it is relevant to their presenting concern. This weight-centric approach can overshadow other health needs and lead to false positives for larger individuals (i.e. misdiagnosing a healthy patient as unhealthy due to weight and prescribing weight loss). An emphasis on weight loss most likely results in weight cycling and cumulative weight gain, which can lead to frustration and termination of healthy behaviors. An alternative to this traditional, weight-based tactic is the Health at Every Size (HAES) program. This philosophy promotes healthy behaviors for individuals of all sizes in an attempt to shift focus away from body weight and toward broader health. The basic conceptual framework includes beliefs in 1) the natural diversity of body sizes and shapes, 2) the dangers of ineffectiveness of weight-loss oriented dieting, 3) the importance of eating based on internal body cues, and 4) the critical contribution of physical, emotional, social, and spiritual factors to health and happiness. HAES discourages the use of externally structured eating regimens, such as counting carbohydrates or calories. Instead, individuals relearn how to eat in response to physiological hunger and satiety cues. HAES also promotes physical activity for improved quality of life and enjoyment, not for weight loss or calorie burning. Rather than concentrating on end-goals of weight-loss, patients notice what foods and behaviors make their bodies energetic and rested and incorporate those into their future behavior. By adopting this mindset, healthcare providers encourage patients to have a process focus for day-to-day quality of life. Traditional Weight-Loss Paradigm For good health... read more

Eating Disorder Groups

Our Eating Disorder treatment team is now offering a variety of groups, for both clinical and subclinical populations. These groups meet weekly with our Certified Eating Disorder Specialist, Cara Reinbrecht, MS, LMHC, NCC, CEDS, or our Registered Dietitian, Amanda Atkinson, MA, RD, CD. Binge Eating Disorder Group Binge Eating Disorder diagnosis required Health at Every Size perspective Find peace with food, body, and self Stopping the Diet Cycle Group Diagnosis of OSFED or Unspecified Feeding or Eating Disorder possible but not required Repetitive dieting struggles Intuitive and mindful eating concepts, body image, and underlying issues Movement component Healthy Bodies/Healthy Futures Group For ages childhood through adolescence Healthful eating patterns, positive body image, positive relationships with food, self-care, and self-esteem Movement component Mindful Nutrition Group Improving one’s relationship with food Intuitive eating Mindfulness activities Eating patterns that are healthful, satisfying, maintainable, and non-emotional Addressing food/diet rules Body Image Group Improve body acceptance Healthy body image, body image self-talk, and body/self-acceptance Eating Disorder Support Group Recovering from an Eating Disorder, diagnosis required Relapse prevention Identify and utilize coping skills Healthy body image work Eating Disorder Family Support Group Family members and caregivers of loved ones struggling with an Eating Disorder Education about Eating Disorders How to support loved ones Tools for... read more

Binge Eating Disorder

DSM Diagnostic Criteria Recurrent episodes of binge eating, which is characterized by eating, in a discrete period of time, an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances, and a sense of lack of control over eating during the episode The binge-eating episodes are associated with three or more of the following Eating much more rapidly than normal Eating until feeling uncomfortably full Eating large amounts of food when not feeling physically hungry Eating alone because of feeling embarrassed by how much one is eating Feeling disgusted with oneself, depressed, or very guilty afterwards Binge eating disorder (BED) has a reported prevalence of 6.6%, with equal proportions in women and men. The prevalence of BED increases to between 9% and 19% in obesity clinic populations and between 9% and 47% among bariatric surgery patients. Obese patients who have BED appear to be significantly older than non-obese patients who have BED. Additionally, as the degree of obesity increases, the prevalence of BED also seems to increase. This suggests that binge eating may be a risk factor for weight gain and/or obesity. It is important to note that obesity itself is not a criterion of BED, and the disorder is clinically significant and distinct from typical obesity. In comparison to obese patients without BED, obese patients with the disorder have lower self-esteem and greater depressive symptoms. Obese patients with BED also have more comorbid psychiatric disorders such as mood, anxiety, and substance use disorders. When comparing individuals diagnosed with BED, obesity, and bulimia nervosa, studies show that... read more

Exercise Addiction

Considering its benefits, both mentally and physically, regular exercise can be viewed as beneficial and even therapeutic. However, when practiced obsessively, rewarding behaviors such as exercise can trigger severe negative consequences. Exercise addiction has been associated with eating disorder traits such as concern for weight and perfectionism. In fact, eating disorders are the most common disorder to co-occur with exercise addiction, although exercise addiction can also be comorbid with other addiction disorders such as substance and alcohol abuse. While the DSM-V lists only gambling under behavioral addictions, researchers have modified the DSM-IV TR criteria for substance dependence to identify exercise addiction. Tolerance: in order to feel the desired effect (a “buzz” or sense of accomplishment), the amount of exercise increases Withdrawal: negative effects such as anxiety, irritability, restlessness, and sleep problems occur in the absence of exercise Lack of control: attempts to cease exercising for a period of time or to reduce exercise level are unsuccessful Intention effects: consistently exercising beyond the intended amount or exceeding the intended routine Time: a great deal of time is spent recovering from, preparing for, and/or engaging in exercise Reduction in other activities: occupational, recreational, and/or social activities occur less often or stop altogether as a direct result of exercise Continuance: continuing to exercise despite the behavior creating or exacerbating psychological, interpersonal and/or physical problems To understand how exercise can become an addiction, clinicians can refer to the “Four Phase” model. In the first phase, exercise is recreational and occurs primarily because it is rewarding and pleasurable. In the second phase, the exercise has become an at-risk behavior, with the exercise becoming more... read more

Nutritional Counseling Services

Center for Hope offers nutritional counseling as part of our multidisciplinary approach to mental health. Our registered and certified dietitian, Amanda Atkinson, MA, RD, CD, provides outpatient and intensive outpatient care for our practice. To achieve optimal health for clients, Amanda collaborates with primary care physicians, psychiatrists, mental health therapists, and other medical providers. Nutritional Services Nutrition Education Meal Planning Sports Nutrition Counseling Personalized Nutritional Health Counseling Amanda is experienced in treating clients with eating disorders, exercise addiction, and maladaptive relationships with food. She strives to help those struggling with eating issues to gain a healthy relationship with food through Intuitive Eating, a philosophy that focuses on mindfulness and where all foods can fit. Environments like the grocery store or a restaurant can trigger dysfunctional thoughts and behaviors for those struggling with disordered eating. Amanda provides assistance navigating those environments to prepare clients for life outside of treatment. Additionally, Amanda provides sports nutrition counseling through the high school level. To sustain peak performance, Amanda ensures athletes have the proper nutrition to complement their physical activity. Non-athletes and those without eating disorder symptoms benefit from one-on-one support regarding nutrition education and meal planning as well. With abounding diets and conflicting theories, it can be a challenge to know what’s true when it comes to food. Amanda helps all clients decipher between nutrition myths and facts so they are able to make informed choices from the grocery store to the dining... read more


Diabulimia Adolescent girls diagnosed with Type 1 diabetes appear to experience a significantly increased rick of eating disorders compared to those without diabetes. Common risk factors for developing an eating disorder include weight gain and a history of dieting and dietary restraint. Type 1 diabetes intensifies these risks due to the tendency to gain weight following the initiation of insulin therapy and the necessity of focusing on food to successfully manage the condition. In addition to their general susceptibility to eating disorders, patients diagnosed with diabetes are uniquely vulnerable to developing diabulimia. Diabulimia, a combination a diabetes and bulimia, is the term used in academic literature and the media to describe the deliberate avoidance or limitation of insulin to control weight. The omission or restriction of insulin results in the purging of calories through glycosuria, which causes weight loss. Efforts are currently being made to include diabulimia as an official diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Warning Signs: Obsession with body size & shape Rapid weight loss Preoccupation with food intake Frequent micturition Hyperglycemia Recurrent ketoacidosis Ketone smell on breath & in urine Poor metabolic control despite appearance of compliance Refusal to let others observe insulin injections Prevention Although not currently recognized as a medical or psychiatric diagnosis, the acknowledgement of diabulimia by healthcare and medical providers is integral. If left undetected, it can cause early on-set kidney failure and retinopathy and ultimately be fatal. Early identification is important as prevention, therefore regular screening for diabulimia should be a fundamental part of diabetes care. A possible tool physicians can use is the Revised 16-item... read more


Orthorexia Defined Dr. Steven Bratman, a general physician and contributor to the natural eating movement, first coined the term orthorexia nervosa in 1997. The disorder is defined as a pathological obsession for biologically pure foods. This fixation on a healthy diet and intense fear of eating anything contaminated can result in elimination of entire food categories, malnutrition, weight loss, and intense social isolation. It is important to note that the desire to eat healthy goods is not pathological itself; the disorder lies in the obsessive, persistent approach to diet along with the withdrawal from life this food habit causes. Orthorexics dedicate a large amount of time to the planning, purchase, preparation, and consumption of food considered to be healthy. Their eating behavior generates a feeling of superiority, and they may refuse to eat away from their home. Ultimately the quality of food consumed is more highly valued than social relationships, personal values, or career plans. Although the term has existed for almost twenty years, studies on orthorexia are not sufficient enough for it to have valid diagnostic criteria. Therefore, it is not included in the DSM or ICD-10. Two diagnostic tools do exist, Bratman’s Orthorexia Test (BOT) and the ORTO-15; however, there is a need for increased reliability in these instruments to allow for a more thorough investigation of the disorder. Orthorexia in comparison to anorexia nervosa Patients with orthorexia, like those with anorexia, give food an immensely disproportionate place in the scheme of life. Orthorexics and anorexics share obsessive personality traits as well as the denial of feelings, conflicts, and bodily signs of fatigue and weakness. Despite these... read more