Part of the difficulties in diagnosing an eating disorder is finding out precisely what's going on, both behaviorally and psychologically. Traditionally, professionals have relied on patients to self-report thoughts and behaviors. Given the secretive nature of eating disorders, this certainly makes sense. There may be other things going on that the sufferer is hiding from friends and family. And a sufferer may not always vocalize their thoughts and feelings to loved ones, perhaps feeling threatened or vulnerable, or not wanting people to worry.
Yet eating disorders--especially anorexia--are anosognostic. That is, the very illness the person has prevents him or her from seeing that they are ill. It's subtly different than denial. When a person is said to be "in denial," which is common with substance abuse and other addictions, he or she inherently knows that something is wrong, but it unwilling or unable to admit it. With anosognisia, the person literally doesn't understand that there is a problem. I wanted to lose weight, and I did, thinks a sufferer. What's the problem?
Which makes the self-reporting of symptoms, behaviors, and thoughts inherently problematic. Researchers in Germany recently compared surveys and forms comparing reports of physical and psychological issues confronted by ED patients. It turns out that parents consistently rated their children as having more severe thoughts and behaviors than their adolescent.
The researchers conclude:
Agreement between parents and adolescents regarding the presence and severity of psychiatric symptoms in adolescents with ED is low. In contrast to previous studies in non-ED samples, adolescents with ED reported lower levels of internalizing problems than their parents. Denial and minimization may be underlying reasons for our findings and represent obstacles in the psychological assessment of adolescents with ED.
Therefore, it is crucial to make sure parents are included not only in treatment, but also in the diagnosis of their child's eating disorder.