Primary Care Docs Diagnose, but Don’t Refer, Eating Disorders

In research presented at this month’s Association for Behavioral and Cognitive Therapies’ annual conference, a team including Stacey Cahn, associate professor, psychology at Philadelphia College of Osteopathic Medicine, and graduate student Ashley Higgins studied the responses of primary care doctors and residents who watched videos of simulated patient interactions. An actor portraying a patient would list a number of symptoms associated with anorexia (without explicitly stating the disease) to another actor portraying a doctor. The viewers would then attempt to identify the cause of the symptoms. Cahn and Higgins found that the doctors were correctly able to identify that a patient either had an eating disorder, or specifically, anorexia, about 60 percent of the time. Yet less than 40 percent recommended follow up with a mental health professional.

Higgins said a larger study would need to be done to explore why it was that so few physicians recommended follow-up. “Doctors can be very intuitive when someone is reporting symptoms, but the problem might be that they are unsure of where exactly to refer their patient, and whether he or she will go (once referred),” she said.

Higgins noted that the symptom that most tipped the doctors off to an eating disorder was the loss of menstruation, coupled with a drastic drop in weight or low weight. “That was a big indicator to the viewers that something was wrong,” she said.

Cahn says that literature suggests anorexia in particular is underdiagnosed, and that the best outcomes rely on early detection. To that end, primary care providers can be a powerful asset. However, she says there are several factors that can make this difficult.

“Primary care doctors receive only a minimal amount of training to recognize anorexia, so they’re not always primed on what to look for, and a patient rarely discloses that he or she has an eating disorder,” Cahn said.