How to identify eating disorders

Many therapists and clinicians graduate without adequate training on how to identify eating disorders in their clients. 

Without specialized education in this area, these potentially life-threatening conditions can go undetected in private practice settings. 

Given that eating disorders are among the deadliest mental illnesses—second only to opioid addiction—knowing how to identify eating disorders is crucial for all clinicians, even those who don’t specialize in their treatment.

In this article, we’ll explore effective screening questions for eating disorders and provide actionable strategies to help ensure your clients receive appropriate care.

​​The importance of universal screening

Eating disorders don’t discriminate. 

They affect people of all ages, races, genders, sexualities, and socioeconomic backgrounds.

However, the presentation may vary significantly across different demographic groups, making identification challenging without proper screening tools.

As clinicians, we have an ethical responsibility to develop competence in how to identify eating disorders, even if we ultimately refer these clients to specialists. 

Sometimes, just a few targeted screening questions for eating disorders can determine whether there’s cause for concern and guide your next steps.

Two essential screening questions for eating disorders

While comprehensive assessments are valuable, these two simple questions can serve as effective initial screening tools when meeting with new clients:

Question 1: Assessing fear of weight gain

“On a scale from 0 to 10—with 10 being the highest—how afraid are you of gaining weight?”

(For bodybuilders or others with specific body composition goals, you might modify this to: “How afraid are you of being fat?”)

Question 2: Evaluating eating patterns

“What do you eat on an average day? Describe to me the type and amount of foods that you eat.”

While these two screening questions for eating disorders don’t address every aspect of disordered eating, they provide valuable insights that can guide further assessment or referral decisions.

How to detect eating disorders from client responses

Interpreting fear of weight gain in responses to Question 1

The first question indirectly assesses pathology by focusing on emotional experience rather than behaviors. 

This approach is particularly valuable because:

1. Many individuals with eating disorders lack insight into their condition.
2. Some clients may wish to continue restrictive behaviors to lose weight.
3. Direct questions about eating struggles might be answered with denial.

If a client reports an intense fear of weight gain—approximately seven or higher on the zero-to-ten scale—it strongly suggests significant eating and body image pathologies. 

In such cases, additional assessment is warranted to determine whether the eating pathology is primary and how urgently intervention is needed.

Evaluating feeding and eating patterns in responses to Question 2

The second question helps identify various eating disorders, including those not primarily driven by weight concerns. 

For example, avoidant/restrictive food intake disorder (ARFID) involves malnutrition similar to anorexia nervosa but without the fear of weight gain. 

Instead, individuals with ARFID may fear negative consequences from eating, such as:

• Choking
• Allergic reactions
• Vomiting
• Aversive sensory experiences (e.g., certain textures such as crunchy, mushy, chewy, etc.)

By asking about daily food consumption, you can identify clients who might be restricting their intake for reasons unrelated to weight concerns.

Red flags in daily food consumption

When clients describe their typical daily intake, watch for these concerning patterns:

1. Food restriction: Consuming inadequate calories (e.g., approximately 1,000 calories or only a few small snacks daily)
2. Food avoidance: Eating a limited variety of foods (e.g., avoiding entire food groups or foods with specific textures)
3. Binge eating: Consuming large amounts in one sitting, often following periods of restriction (e.g., eating very little during the day followed by excessive consumption at night)

Additional eating disorder questions to ask

If initial screening raises concerns, consider these follow-up questions as part of a more comprehensive eating disorder intake assessment:

• “Do you count calories or try to limit your food intake?”
• “Do you avoid specific foods for any reason?”
• “Do you feel out of control when you eat?”
• “Do you ever do anything to ‘make up’ for eating, such as exercise, take laxatives, take diet pills, or intentionally vomit?”

These questions can help distinguish between different types of eating disorders and assess the severity of symptoms.

Further disordered eating screening tools

When initial screening indicates possible eating pathology, consider implementing standardized assessment tools. 

The EAT-26 (Eating Attitudes Test) is a widely used, free 26-item questionnaire that can provide additional information to guide clinical decision-making.

For clients presenting with restrictive eating patterns, specific anorexia screening questions may be appropriate. 

These might include more detailed inquiries about:

• Body image disturbance
• Menstrual irregularities (in applicable clients)
• Recent weight changes
• Exercise patterns

When to refer

Eating disorders such as anorexia nervosa, bulimia nervosa, ARFID, or other specified feeding or eating disorder (OSFED) are typically considered primary disorders due to their potentially life-threatening nature. 

Even binge-eating disorder, while sometimes perceived as less medically urgent, warrants specialized treatment to prevent progression to more dangerous behaviors like purging.

If you don’t have specialized training in treating eating disorders, making an appropriate referral is a crucial part of ethical practice. 

Resources for finding qualified specialists include:

• Academy for Eating Disorders (AED)
• International Association for Eating Disorder Professionals (IAEDP)
• Local eating disorder treatment centers

Professional development resources

For clinicians interested in developing greater competence in how to identify eating disorders and provide appropriate treatment, consider:

1. Professional organizations: Join AED or IAEDP for access to training and resources
2. Literature:
   • “Overcoming Binge Eating” by Christopher Fairburn, MD
   • “Cognitive Behavior Therapy and Eating Disorders” by Christopher Fairburn, MD
   • “Treating Eating Disorders in Adolescents” for those working with younger populations

Conclusion

Learning how to identify eating disorders through effective screening is an essential skill for all mental health professionals. 

By incorporating these screening questions for eating disorders into your intake process, you can ensure that clients with these potentially life-threatening conditions don’t fall through the cracks.

Even if you ultimately refer these clients to specialists, your ability to recognize warning signs and initiate appropriate referrals can make a critical difference in their recovery journey. 

Through ongoing education and a commitment to comprehensive assessment, you can fulfill your ethical obligation to provide the best possible care to all clients—including those struggling with eating disorders.

Remember: When in doubt about how to proceed after identifying potential eating disorder symptoms, consultation with specialized colleagues can provide valuable guidance and support.

How SimplePractice streamlines running your practice

SimplePractice is HIPAA-compliant practice management software with everything you need to run your practice built into the platform—from booking and scheduling to insurance and client billing.

If you’ve been considering switching to an EHR system, SimplePractice empowers you to run a fully paperless practice—so you get more time for the things that matter most to you.

Try SimplePractice free for 30 days. No credit card required.