Identifying an eating disorder
Early signs of eating disorders
Physical – loss of weight, fainting/dizziness, loss of energy, muscle weakness, sleep disturbance, susceptibility to infection, loss of menstruation, constipation/bloating, repeated vomiting, swollen glands under the jaw or frequent dental problems (if there is repeated vomiting).
Behavioural changes – counting calories, restricting the amount or range of food eaten, eating alone or missing meals, secretiveness, hiding food, frequent visits to the toilet, taking a long time to eat meals, cutting food into small pieces, excessive body-checking, over-exercising, wearing baggy clothes.
Psychological – preoccupation with food and eating, concerns about weight and shape, feeling compelled to restrict intake, fear of eating.
Non-specific signs that may accompany eating disorders
Psychological – low mood, loss of interest, poor concentration, withdrawal, disturbed family relationships
Social/educational – withdrawal from family and friends, loss of interest in activities, poor concentration, difficult family relationships
NB The non-specific signs may also be a feature of other mental health disorders such as depression or anxiety
- Diagnostic features
- Weight loss at least 15% below the body weight expected (or BMI less than 17.5) or failure to gain weight as part of normal growth and development.
- Weight loss is self-induced by avoidance of “fattening “ foods
- Over-evaluation of weight or shape
- Abnormal hormonal function (loss of menstruation in females)
- Recurrent binge eating
- Purging (self-induced vomiting, laxative or diuretic abuse, restrictive dieting or over-exercise)
- Over-evaluation of weight and shape
Atypical eating disorders
- Eating disorder symptoms that do not meet all the above criteria although cause significant concern/impact (common in young people).
Assessment in primary care
Clarification of history and symptoms of eating disorder as above, along with a brief summary of family and personal background. Useful questions (some adapted from the SCOFF questionnaire) include:
- Are you trying to lose weight?
- Do you ever make yourself sick after eating?
- Do you worry about losing control of your eating?
- Do you think you are fat when others say you are too thin?
- Would you say that food dominates your life?
Physical assessment and investigations
If an eating disorder is suspected, physical assessment is indicated to exclude other causes of low weight and identify any physical consequences of the disorder.
This will include weight and height, BP and PR as well as more general examination to exclude other causes of weight loss. For those with low pulse rate (under 50) an ECG may be indicated to identify any serious cardiac abnormalities.
Recommended initial blood investigations include: FBC; ESR/CRP; urea and electrolytes (including phosphate, Mg, Ca); liver function tests, glucose, folate, B12; Iron; coeliac screen, thyroid function tests.
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Page last reviewed: 18 January, 2023