Eating disorder diagnoses in general practice settings: Comparison with structured clinical interview and self-report questionnaires

Abstract

Background. Accurate diagnosis of eating disorders may facilitate appropriate management of the conditions. Currently, little information is available regarding the accuracy of eating disorder diagnoses made in routine primary care.Aims. To evaluate the accuracy of eating disorder diagnoses made in primary care settings, and to compare the accuracy of primary care diagnoses with those generated using patient self-report questionnaires.Method. Participants were 212 consecutive referrals to an outpatient eating disorder programme, who were found to have a DSM-IV eating disorder upon assessment with the Eating Disorder Examination (EDE). Primary care diagnoses were taken from referral letters and forms. Self-report diagnoses were generated using self-report responses to the Eating Disorder Examination-Questionnaire (EDE-Q).Results. Primary care practitioners were accurate in identifying anorexia and bulimia nervosa, but inaccurate in identifying atypical presentations (e.g. eating disorders not otherwise specified [EDNOS]). Convergence between the EDE and the EDE-Q was modest, and the EDE-Q tended to overestimate the incidence of EDNOS.Conclusion. ‘Atypical’ eating disorder presentations tend to be misdiagnosed in primary care settings, although practitioners are generally accurate in distinguishing between anorexia-like and bulimia-like presentations. This has implications for the management of eating disorders in primary care settings.