Diagnostic Protocol: Anorexia Nervosa

Brooke Silva
University of Utah

Diagnostic Grouping

Feeding and eating disorders are characterized by a persistent

disturbance of eating or eating-related behavior that results in
the altered consumption or absorption of food and that
significantly impairs physical health or psychosocial functioning.
Feeding and eating disorders are often, but not always, brought
on by a stressful life event.

Specific Diagnosis

There are three essential features of anorexia nervosa: persistent

energy intake restriction; intense fear of gaining weight or of
becoming fat, or persistent behavior that interferes with weight
gain; and a disturbance in self-perceived weight or shape. The
level of severity is measured by current body mass index (BMI)
for adults and BMI percentile for children and adolescents.
o Etiology
Temperamental
Environmental
Genetic
Physiological
Restricting Type- Individual has not engaged in recurrent
episodes of binge eating or purging behavior during the last
three months. This subtype describes presentations in which
weight loss is accomplished primarily through dieting, fasting,
and/or excessive exercise.
Binge-Eating/Purging Type- The individual has engaged in
recurrent episodes of binge eating or purging behavior
throughout the past three months.

Identified Problems (Symptoms Related to Recreational Therapy)

Physical
o Fatigue and weakness
o Dizziness or fainting
o Low bone mineral density (elevated risk of fracture)
o Abnormally slow heart rate, and low blood pressure
Emotional
o Elevated suicide risk
o Self-esteem overly related to body image, low self esteem
o Fear of gaining weight
o Depression
o Irritability

o Flat mood, flat affect

o Difficulty expressing emotions directly
Social
o Significant social isolation, social withdrawal
o Lack of identity
Cognitive
o Failure to fulfill academic or career potential

Related Factors

Bipolar, depressive, and anxiety disorders

Obsessive compulsive disorder (OCD)
Substance abuse
Osteoporosis
Organ damage
Family issues

Assessment Criteria
Assess physical strength and stamina through standardized
testing
Assess previous and current leisure participation patterns
through standardized testing
Assess leisure interests and barriers through formal interview
Assess social skills through standardized testing
Assess self-esteem through standardized testing
Record review from physician
Record review from dietician
Record review from physical therapist/occupational therapist
Process Criteria

Leisure education
Expressive art
Coping skills strategies
Stress management
Self-esteem building
Social skills
Yoga program

Outcome Criteria

Increase leisure knowledge and skills

Identify and apply coping skills

Demonstrate increased strength and flexibility
Increase feelings of self worth and set realistic expectations of
self
Develop a sense of trust in self and others
Brooke Silva TRS, CTRS (Student)

References
American Psychiatric Association. (2013). Diagnostic and Statistical
Manual of Mental Disorders: Fifth Edition. Arlington, VA: American
Psychiatric Association. Retrieved October 5, 2015, from
https://docs.google.com/ file/d/0BwDYtZFWfxMbWs2UC1WdWJzZTQ/edit?pli=1
Frisch, M.J., Franko D.L., & Herzog. (2006). Art-Based Therapies in the
Treatment of Eating Disorders [Abstract]. Eating Disorders: The
Journal of Treatment & Prevention, 14(2), 131-142. DOI:
10.1080/10640260500403857
Gilbert, A., Ferries, L., Smale, B., & Rehman, L. A Research Approach to
the Redesign of a TR Assessment Process. Retrieved October 5,
2015, from
http://lin.ca/sites/default/files/attachments/sp001074.pdf
Mayo Clinic. (2015). Anorexia Nervosa. Retrieved October 5, 2015, from
http://www.mayoclinic.org/diseasesconditions/anorexia/basics/symptoms/con-20033002
National Eating Disorders Association. (2015). Anorexia Nervosa.
Retrieved October 5, 2015, from
https://www.nationaleatingdisorders.org/anorexia-nervosa