In the early 1980s, Levitt and Reid (1981) coined the term Rapid Assessment Instruments in reference to clinical tools that were brief, relatively quick to administer and score, repeatable and useful for client assessment as well as a way of tracking clinical progress. Over the years, the field of Eating Disorders has propagated quite a number of these instruments but they are either difficult to locate or expensive to use. These has indeed posed a problem for clinicians who are expected to have methods of measuring various client conditions and for measuring client outcomes, but have limited access to tools that could assist them.
RAIs are extremely valuable to Eating Disorder clinicians and clients namely that client presentations are frequently complex and/or associated with a variety of co-morbid conditions. Indeed, it is not uncommon for Eating Disorder clients to present with symptoms or problems related to trauma (e.g., PTSD), self-injury, substance abuse, affective disorders, or anxiety disorders. During assessment and treatment, tools to monitor the client's general functioning (i.e., social, relational, and so forth) as well as their Eating Disorder related conditions which can include dieting, exercise, binging/purging, and so forth would be quite useful if they were readily available to clinicians.
Surprisingly, many clinicians already use a variety of published or self-developed tools. It is not uncommon for clinicians to have found or developed inventories on beliefs, values, behaviors, or attitudes toward self or food, family, weight, etc., or use food diaries, mood logs, or semi-formalized Subjective Unit of Distress Scales (SUDS). They use these instruments to understand the client conditions, as well as provide information throughout treatment. Below are a few examples of how these instruments might be employed.
Example One: Mark has sought treatment for an EDNOS - binging without purging, depressed mood, and memory intrusions of his molestation as a child. As part of a comprehensive Eating Disorder and psychological assessment, Mark and the therapist developed brief tracking measures of binges (as defined by Mark with the therapist) and intrusions (as defined by Mark/therapist) along with the use of a familiar depression inventory. After developing these together and collecting initial data (i.e., baseline), the RAIs for binges and intrusions are used weekly and the depression inventory bi-weekly to help the client keep track of his progress. Indeed, by developing the binge and intrusion RAI to be client-specific, Mark and the therapist were also able to identify particular triggers for the binges/intrusions as well as identify the symptom clusters and patterns. They were also able to evaluate the overall efficacy of the treatment(s).
One advantage illustrated here is that the therapy is tracking behaviors based on the client's definition of his experiences, even though there are also a number of formal instruments for measuring symptoms of PTSD, binging and other areas that could also be used.
Example Two: Mary presents in treatment for anorexia nervosa and uses laxatives to control her weight and alcohol and self-injury to manage her moods. After a thorough assessment, Mary and the clinician identify that Mary's mood changes occur fairly often and she initially recognizes this by an "I feel fat" thought/feeling. This is often, but not always, followed by self-injury (SIB) and/or consumption of alcohol.
The therapist used the Eating Attitude Test (EAT-26,) with the client. Mary/therapist put together a thought log that would track the "I feel fat" thoughts and a five point SUDS scale for measuring timing and discomfort around the thought/feeling. They also put together a diary to measure aspects of drinking (i.e., thoughts, setting, triggers, etc.) and a similar one for SIB. Initially, the drinking/SIB diaries were used to evaluate the triggers, frequency, and intensity of the behaviors. Then these instruments were used weekly for tracking and for discussing the client's experiences and efforts during interventions.
The above examples are simplistic and provided for illustrative purposes only. There are a number of other instruments available for a fee or discussed in books; such as the EDQ in Mitchell and Peterson (Eds.) Assessment of Eating Disorders, NY: Guilford Press, 2005.
If interested, please email me at [email protected] and I will forward to you a brief list of some other relevant resources or RAIs. Please note that some of these might be difficult or expensive to locate or obtain.
About John Levitt, PhD:
Dr. Levitt has been treating eating disorders, trauma, and self-injury patients for over 30 years. He has authored numerous articles and books as well as spoken and trained clinicians, nationally and internationally, on these topics. He can be reached at (847) 370-1995 or emailed at [email protected].