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.