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What medical diagnostic tests do eating disorder clinics insist on to rule out medical illnesses before accepting patients into their programs? We contacted several eating disorder clinics in North America and asked them this exact question. Here are their responses:
Rader Programs : We have never heard of a medical test that could rule on or out an eating disorder. The complications can be so varied and severe that it really requires multidisciplinary assessments to find out what is going on.
The Renfrew Center: No response
Remuda Ranch: When patients are referred to Remuda Ranch, a basic diagnosis of an eating disorder has already been established. Once the patient is at Remuda, we get a current assessment of their medical status by obtaining:
1. Chemistry Panel including lytes, calcium, phosphorus, magnesium, lipids, BUN, creatinine, liver functions
2. CBC
3. TSH
4. Urinalysis
5. Hepatitis B surface antigen assay
6. Urine pregnancy test
7. Urine drug screen
The patients tuberculin status is also assessed and a PPD done if indicated.
As for other medical evaluations with procedures such as echocardiography or GI endoscopy, a decision is made as to the urgency of the evaluation and it is obtained if needed.
Harvard Eating Disorder Clinic: No response
Montreux Eating Disorder Clinic (Victoria, B.C.): No response
B.C. Children's Hospital (Vancouver B.C.): No response
St. Paul's Hospital (Vancouver, B.C.): No response
Johns Hopkins Hospital (Baltimore MD): No response
Mayo Clinic (Rochester, MN): No response
Preliminary Conclusion:
Despite the fact that almost every anorexic or bulimic patient presents with similar symptoms and behaviors, there is no standard diagnostic protocol used to rule out underlying medical disorders that may be causing anorexia, weight loss, early satiety, malabsorption, nausea, or vomiting. This despite there being a myriad of medical disorders that can cause these symptoms.
No attempt is made to ensure that the original diagnosis is correct. Medical testing only focuses on complications of malnutrition, vomiting, or laxative and diuretic abuse.
Did the physician and psychiatrist who originally made the diagnosis of AN or BN run enough tests to rule out medical disorders? If any of the tests noted on the medical tests page were omitted, it is very likely they did not.
Almost universally, treatment will consist of forced or tube feeding for seriously malnourished patients, psychotherapy, family therapy, and antidepressant therapy. Because eating disorders are assumed to be due to psychological or emotional problems, little consderation will be given to underlying medical disorders. How many patients in these programs are suffering from a chronic medical disorder that makes it difficult for them to eat or gain weight? We will never know until all receive extensive diagnostic testing to rule out differential diagnoses.
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