Specialist Psychosocial Assessment of Eating Disorders

A specialist eating disorders assessment should be holistic and integrated, comprising both psychosocial and medical assessments. The medical component of the assessment comprises the physical examination and assessment of medical risk. The larger psychosocial component focuses on all the other factors necessary for determining whether an eating disorder is present, and the context in which it developed and might be maintained. The key factors in a psychosocial assessment are psychological, psychotherapeutic, family, social, and diagnostic. The psychosocial and medical components of the assessment are synergistic. They aim to fulfill a range of functions: First, engage the patient and, if present, any family members, in order to instill optimism and hope for successful treatment. Then the assessor, along with other members of the multidisciplinary team (MDT), will collect information from the referrer, the patient, and the family to confirm or exclude one or more psychiatric and medical diagnoses. These are then combined, together with a medical assessment, to produce an assessment of risk. The information collected is then woven into a formulation (Division of Clinical Psychology (2011)), collaboratively. This conveys how the assessor, and ideally patient and family, sees the development of the problem, including predisposing, precipitating, perpetuating, and protective factors, in biological, psychological, and social-cultural realms. Lastly, with the help of the MDT, the assessor develops a management plan and often, especially in younger patients, begins to implement that plan on the assessment day. Following the assessment, a report is written containing the essentials of diagnosis, risk assessment, formulation, and management plan, and sent to the referrer, usually with a copy for the patient. All these areas, with the exception of physical examination and risk assessment which is covered elsewhere in this book, will be discussed in this chapter with reference to patients of any age. Consideration will be given to approaches which are specific to either child and adolescent or adult age ranges.