Uncovering Bulimic Disorders in Primary Care

Currently only a small minority of bulimic-type eating disorders are first identified in primary care settings, due to secrecy on the part of patients and a need for more knowledge about bulimic disorders by patients and physicians alike. The results from a small study in two urban regions of the U.S. underscore the importance of improving the “mental health literacy” among both patients with undetected eating disorders and primary care physicians (J Clin Psychol Med Settings 2010; 17:56).

Dr. Jonathan M. Mond and colleagues at the University of Western Sydney, Australia, and the Neuropsychiatric Research Institute, Fargo, ND, assessed 24 women with bulimic-type eating disorders who regularly visited primary care practices. Information packets were mailed to 500 women over a 3-month period; 257 completed questionnaires (51.4%) were returned. The packets included a six-page questionnaire, a cover letter outlining the nature and purpose of the study, consent forms and prepaid envelopes. The questionnaire included measures of eating disorder psychopathology, quality of life, height and weight, and sociodemographic information. Body mass index (BMI, kg/m²) was calculated from the self-reported height and weight.

All women who returned a completed questionnaire were asked to participate in a second phase of the study, which was a telephone interview that included diagnostic items of the Eating Disorder Examination (EDE). Interviews were completed with 147 women.

Results

Although two-thirds of the women recognized they had a problem with their eating behavior, fewer than 40% had ever sought treatment from a health professional for an eating or weight problem, and only 1 in 10 had sought such treatment from a mental health specialist. Only a third of the women had ever been asked about problems with eating by a primary care practitioner or other health professional. However, more than 80% of the subjects had sought treatment from a general health professional for symptoms of anxiety or depression.

Most of the women reported having some degree of discomfort discussing eating problems with family members, close friends, or a health professional and half reported that they would not be truthful about such problems if asked. One-third of the women did not recognize that they had a problem with their eating.

The authors suggest that there is ample opportunity for primary care physicians to work with patients to improve recognition and managedment of bulimic eating disorders because these patients are likely to seek treatment in relation to general psychological distress and medical conditions. When a patient presents with these complaints, and if there is evidence of a preoccupation with weight, shape, or dietary intake, a few questions about eating attitudes and behaviors can be asked. Two questionnaires that may be very helpful in such situations are the Patient Health Questionnaire (Spitzer, Kroenke, and Williams, 1999) and the SCOFF questionnaire (Morgan et al. 1999). Both have good sensitivity and specificity in a primary care setting and therefore are suitable for determining whether further assessment may be needed.