Evidence-based assessment/Anorexia nervosa (assessment portfolio)

What is a "portfolio"?
For background information on what assessment portfolios are, click the link in the heading above. Want even 'more' information about this topic? There's an extended version of this page here.

Diagnostic criteria for anorexia nervosa
ICD-11 Criteria

Anorexia Nervosa is characterized by significantly low body weight, which is less than minimal normal/expected weight for the individual’s height, sex, age and developmental stage (body mass index (BMI) less than 18.5 kg/m2 in adults and BMI-for-age under fifth percentile in children and adolescents) that is not due to another health condition or to the unavailability of food. Low body weight is accompanied by a persistent pattern of behaviors to prevent restoration of normal weight, which may include behaviors aimed at reducing energy intake (restricted eating), purging behaviors (e.g., self-induced vomiting, misuse of laxatives), and behaviors aimed at increasing energy expenditure (e.g., excessive exercise), typically associated with a fear of weight gain. Low body weight or shape is central to the person's self-evaluation or is inaccurately perceived to be normal or even excessive.

Changes in DSM-5


 * The diagnostic criteria for anorexia nervosa changed slightly from DSM-IV to DSM-5. Summaries are available here and here.

Base rates of anorexia nervosa in different populations and clinical settings
This section describes the demographic setting of the population(s) sampled, base rates of diagnosis such as prevalence rates, country/region sampled, and the diagnostic method that was used. Using this information, clinicians will be able to anchor the rate of adolescent depression that they are likely to see in their clinical practice.


 * To see prevalence rates across multiple disorders, click here.

Psychometric properties of screening instruments for anorexia nervosa
The following section contains a list of screening and diagnostic instruments for eating disorders, including anorexia nervosa. The Eating Disorder Diagnosis Scale (EDDS) outputs diagnostic categories of various eating disorders based on the DSM. The section includes administration information, psychometric data, and PDFs or links to the screenings.
 * Screenings are used as part of the prediction phase of assessment; for more information on interpretation of this data, or how screenings fit in to the assessment process, click here.


 * For a list of more broadly reaching screening instruments, click here.

Note: Reliability and validity are included in the extended version. This table includes measures with Good or Excellent ratings.

Likelihood ratios and AUCs of screening instruments for anorexia nervosa

 * For a list of the likelihood ratios for more broadly reaching screening instruments, click here.

Interpreting anorexia nervosa screening measure scores

 * For information on interpreting screening measure scores, click here.
 * Also see the page on likelihood ratios in diagnostic testing for more information.

Gold standard diagnostic interviews

 * For a list of broad reaching diagnostic interviews sortable by disorder with PDFs (if applicable), click here.

Recommended diagnostic interviews for anorexia nervosa
Note: Reliability and validity are included in the extended version. This table includes measures with Good or Excellent ratings.

Process phase
The following section contains a brief overview of treatment options for anorexia nervosa and a list of process and outcome measures for anorexia nervosa. The section includes benchmarks based on published norms for several outcome and severity measures, as well as information about commonly used process measures. It is worth noting, however, in inpatient or other acute care settings, weight restoration is the primary goal of treatment for anorexia nervosa, making body weight the most closely monitored process indicator. Process and outcome measures are used as part of the process phase of assessment. For more information on the differences between process and outcome measures, see the page on the process phase of assessment.

Process measures
Body weight is commonly monitored by clinicians throughout the AN treatment process as helping individuals regain and maintain a healthy weight is a primary treatment goal for AN. Many treatment centers have policies prohibiting patients from seeing their weight.

Motivational Stages of Change may be used to monitor individuals’ readiness to take action against eating disorder behaviors. It has demonstrated predictive validity in a sample of female adolescents attending eating disorder treatment groups. See Appendix E.

Outcome and severity measures
This table includes clinically significant benchmarks for anorexia nervosa specific outcome measures
 * Information on how to interpret this table can be found here.
 * Additionally, these vignettes might be helpful resources for understanding appropriate adaptation of outcome measures in practice.
 *  For clinically significant change benchmarks for the CBCL, YSR, and TRF total, externalizing, internalizing, and attention benchmarks,  see here.

Note: “A” = Away from the clinical range, “B” = Back into the nonclinical range, “C” = Closer to the nonclinical than clinical mean.

Search terms: [Anorexia Nervosa OR eating disorder] AND [validity OR clinical significance] in Google Scholar

Treatment

 * Treatment of AN typically consists of restoring the individual to a healthy weight and addressing thoughts and behaviors which are related to the eating disorder. It may involve re-nutrition, psychotherapy, nutritional counseling, and medication.
 * Literature reviews of existing research indicate that evidence supporting AN treatment is lacking. A systematic review of AN treatment efficacy studies by Bulik found that evidence supporting medications, medications and behavioral interventions, and behavioral interventions alone in adults is weak.
 * There is moderately strong evidence suggesting that behavioral interventions may be helpful for adolescents. In particular, adolescents may benefit from family therapy.
 * Clinical trials investigating AN treatment suffer from high rates of attrition, as key features of AN (e.g., denial, fear of weight gain) may contribute to low motivation for remaining in treatment.
 * More severe cases of AN may be treated in inpatient settings, which are equipped to manage the re-nutrition process and provide medical monitoring.
 * Partial hospitalization and intensive outpatient programs may provide intermediate levels of treatment intensity to assist individuals in the transition from intensive care to outpatient care after weight restoration.


 * Please refer to the page on anorexia nervosa for more information on available treatment or go to the Effective Child Therapy page for Eating & Body Image Problems for a curated resource on effective treatments for anorexia nervosa.

External resources

 * 1) ICD-10 diagnostic criteria
 * 2) Find-a-Therapist
 * 3) This is a curated list of find-a-therapist websites where you can find a provider
 * 4) NIMH: Eating Disorders--About More Than Food  and Eating Disorders
 * 5) These NIMH website posts provide more information on anorexia nervosa
 * 6) John's Hopkins Resource (guide about anorexia nervosa, treatment, and more)
 * 7) OMIM (Online Mendelian Inheritance in Man)
 * 8) Anorexia nervosa
 * 9) Effective Child Therapy page for anorexia nervosa
 * 10) Effective Child Therapy is website sponsored by Division 53 of the American Psychological Association (APA), or The Society of Clinical Child and Adolescent Psychology (SCCAP), in collaboration with the Association for Behavioral and Cognitive Therapies (ABCT). Use for information on symptoms and available treatments.