Diagnostic Protocol

Diagnostic Grouping
Feeding and Eating Disorders: Feeding and eating disorders are characterized by a persistent
disturbance of eating or eating-related behavior that results in the altered consumption or
absorption of food and that significantly impairs physical health or psychosocial functioning.
Diagnostic criteria are provided for pica, rumination disorder, avoidant/restrictive food intake
disorder, anorexia nervosa, bulimia nervosa, and binge-eating disorder. (DSM 5, 2014)

Specific Diagnosis
Anorexia Nervosa: an eating disorder characterized by an abnormally low body weight, intense
fear of gaining weight and a distorted perception of body weight. People with anorexia place a
high value on controlling their weight and shape, using extreme efforts that tend to significantly
interfere with activities in their lives.

Diagnostic Criteria
1. Restriction of energy intake relative to requirement, leading to a significantly low body weight in
the context of age, sex, developmental trajectory, and physical health.
2. Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with
weight gain, even though a significantly low weight
3. Disturbance in the way in which one's body weight or shape is experienced, undue
influence of body weight or shape on self-evaluation, or persistent lack of recognition of the
seriousness of the current low body weight.

Two Types of Anorexia

1. Binge/Purging Anorexia
Those with Binge/Purging Anorexia type usually restrict their food intake but also
regularly engage in binge eating and/or purging behaviors (i.e. self-induced vomiting or
the misuse of laxatives, diuretics or enemas).
2. Restrictive Anorexia
When someone restricts their diet to the point of starvation and have an intense fear of
gaining weight. They have an abnormal preoccupation of food and food issues.

Signs and Symptoms

Weight and shape concerns
Dramatic weight loss, or failure to make expected weight gains during periods of normal growth
Excessive weighing of oneself; setting progressively lower and lower goal weights
Other body checking behaviors such as looking in mirrors, measuring or assessing body parts or
frequently asking others for reassurance with questions like do I look fat?
Changes in weight
Frequent comment about feeling fat or overweight
Body distortions
 Excessive exercise
Food and Eating Behaviors
Denial of hunger
Dieting, restricting or otherwise limiting food intake
Rigid counting/calculating of calories and/or fat grams
Refusal to eat certain foods, progressing to restrictions on entire categories of food
Collecting or hoarding recipes
Cooking elaborate meals for other people but not eating the food
Developing of food rituals
Possible use of laxatives, diet aids or herbal weight loss products
Consistent excuses to avoid mealtimes or situations involving food

Identified Problems
Changes in Personality and Social Behavior
Increasing isolation; withdrawal from friends and activities that were once enjoyed
Symptoms of depression and anxiety
Irritability, moodiness
Interpersonal conflicts
Defensive stance when confronted about weight or eating behaviors
Cognitive Dysfunction
Decreases ability to concentrate and focus
Decreases ability to listen and process information
Leads to deficiencies of specific nutrients, such as iron, which has an
immediate effect on individuals memory and ability to concentrate

Related Factors
Emotional/Social/Cognitive Factors
Perfectionism
Low self-esteem
Forced withdrawal from school or college
Loss of connection to faith or religion
Career destruction
Isolation from friends and family
Depression and anxiety
Physical Factors
Dehydration
Fatigue
Dizziness or fainting
Suicide
Infertility
Shutdown of major body systems
Brain Damage
Heart attacks

Process Criteria
Interpersonal Development program
 Designed to help patients identify and address current interpersonal problems such as
perfectionism, low self-esteem, and reduced interest in sex.
Spiritual program
Redefining individuals spirituality and/or becoming well rounded and
educated with different religions
Family therapy program
With eating disorders, the focus is on the eating disorder and how this impacts family
relationships, emphasizing in the early stages of treatment the necessity for parents to
take a central role in supporting their childs efforts to eat.
Stress management program
Designed to help cope with stress management skills.
Depression and Anxiety program
Cognitive Behavioral Therapeutic program
A psychological intervention that is designed to enable people to establish links between
their thoughts, feelings, or actions and their current or past symptoms and to re-evaluate
their perceptions, beliefs or reasoning about the target symptoms.

Outcome Criteria
Adolescent females with eating disorders will:
Improve their confidence by participating in the interpersonal development
program that will help them gain self-assurance
Improve their knowledge about religion by joining in on the religious program and
participating in charity events, prayer, and other religious activities.
Increase family relationships by partaking in the family therapy program and
setting goals together as a family.
Demonstrate stress management skills to address personal stressors.
Develop knowledge of coping skills for depression and anxiety to assist in
early identification of early symptoms.
Recover their cognitive behavior by participating in an intervention
designed to enable their thoughts, feelings, or actions to be re-evaluated.

H. Jardine TRS, CTRS (Student)