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Eating disorders - Management
How do I know my patient has it?

  • The diagnosis of an eating disorder is made on the basis of the history and suggestive clinical features. This is supported, where possible, by corroboration from a relative or friend [National Collaborating Centre for Mental Health, 2004]. See:
  • Be aware that eating disorders [National Collaborating Centre for Mental Health, 2004]:
    • Are often difficult to detect in primary care, as people are slow to present and may only do so when persuaded by concerned family members or friends.
    • Can occur in children, men, and those from ethnic minority groups.
    • May present with non-specific symptoms, for example fatigue, dizziness, or lack of energy, or physical complications associated with starvation, purging, and vomiting [Wilhelm and Clarke, 1998; Pritts and Susman, 2003; Williams et al, 2008].
  • Have a lower threshold for suspecting an eating disorder in [National Collaborating Centre for Mental Health, 2004]:
    • Young women with low body mass index (BMI) compared with age norms.
    • People consulting with weight concerns who are not overweight, or who are underweight.
    • Women with menstrual disturbances or amenorrhoea.
    • People with gastrointestinal symptoms.
    • People with physical signs of starvation or repeated vomiting.
    • Young people with Type 1 diabetes and poor treatment adherence.
    • Children with poor growth.
  • Women with psychological or psychiatric illness should be considered to be at risk of an eating disorder.
  • To help clarify any suspicion that an eating disorder might exist consider:
    • Asking the following questions [National Collaborating Centre for Mental Health, 2004]:
      • 'Do you think you have an eating problem?'
      • 'Do you worry excessively about your weight?'
    • Using the SCOFF questionnaire. Two or more positive answers are suggestive of a case and indicate that further interview and examination are required [Morgan et al, 1999; Morgan et al, 2000].
      • Do you ever make yourself sick because you feel uncomfortably full?
      • Do you worry you have lost control over how much you eat?
      • Have you recently lost more than one stone in a 3-month period?
      • Do you believe yourself to be fat when others say you are too thin?
      • Would you say that food dominates your life?
    • Asking further questions which may help elicit behaviour and thought patterns suggestive of an eating disorder [King's College London, 2009]:
      • Do you avoid eating with others?
      • Which foods feel 'safe' and which do you avoid?
      • What do you consider your ideal weight to be?
      • How would you feel about gaining weight?
      • Do you ever get depressed or feel guilty?
      • Has your life become more ritualized?
      • Do you have compulsions to do things such as bingeing?
      • Do you ever exercise excessively, or abuse laxatives and/or diuretics?

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