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•Of all mental illnesses, anorexia nervosa (AN) has the highest
mortality rate
•By the time ‘obvious’ signs of eating disorders (EDs) have
manifested, it is likely the behaviours are so ingrained in patients
that treatment is harder and less successful
•Early intervention is a critical factor in determining the success
of treatment for EDs
•The role of the primary care professional is to identify EDs, do
initial biochemical investigations and refer early for assessment
•Use this guide on placement or at work when seeing patients
•It will help you know when to consider an ED as a diagnosis even
when disordered eating is not the presenting complaint, the signs
and symptoms to look out for, how you can explore the diagnosis
and when you should be referring patients for further assessment
Why is this SO Important?
Anorexia)Nervosa)(AN) Bulimia)Nervosa (BN)
•Restriction of#energy#intake#
relative#to#requirements,#leading#
to#low#body#weight#
•Intense#fear)of)gaining)weight)
or#becoming)fat)
•Disturbance)in)body)image)
•Atypical AN:
•All#criteria#met#for#AN#
except
significant#weight#
loss;##weight#remains#
normal
•Recurrent#episodes#of#binge)
eating*
•Recurrent inappropriate#
compensatory)behaviors)to#
prevent#weight#gain:#
vomiting,#exercising,#laxative#
misuse#or#fasting#
•
Over#concern#regarding#shape#
and#weight#
Binge Eating)Disorder)(BED))
•Recurrent and#persistent episodes#of#binge)eating
•Episodes#of#binging#associated#with#3#or#more#of:
oEating faster than#normal#
oFeeling#uncomfortably full)
oEating#large)amounts)of#food#when#not hungry)
oEating alone due#to#embarrassment of#food#consumption
oFeeling#disgusted with#oneself#
•Distress regarding#binge#eating#
•Absence)of#regular#compensatory#behaviours#
*#Consumption#of#unusually#
large#amounts#of#food#in#a#
brief#period#of#time#with#
feelings#of#loss#of#control##
EDs#do#not#
discriminate;#they#
can#affect#anyone#
The A- Z of ED Signs and Symptoms
Appetite#change
Bradycardia,#Beau#Lines#
Cold#Intolerance#
Distorted#body#image#
Excess#fine#body#hair#
Fear#of#fatness#
Growth#Restriction#
Hair#thinning;)Hypotension
Inappropriate#dress#for#the#weather#
Jittery#due#to#anxiety
Knuckle#calluses#
Low#body#weight#
Mood#changes
New#dieting#behaviour#
Obsessive#behaviour#
Poor#concentration#
Quality#of#life#reduced#
Rigid#exercise#regime#
Social#withdrawal
Tooth#discoloration#
Unexplained#hypokalemia#
Vomiting#
Water#intake#is#excessive#
Xerosis#(dry#skin)#
Yellowing#of#the#skin##
Zzzz#due#to#insomnia##
Looking#a#
‘healthy#
weight’#
doesn’t#
automatically#
rule#out#the#
diagnosis#
Syncope
Amenorrhoea:
primary or
secondary
Reduced Libido/
Impotence
Anxiety and
Depression
Delayed Puberty
Constipation
Oesophagitis or
Dysphagia
Common presentations include:
Abdominal pain
associated with
vomiting or food
restriction
Renal Calculi
Palpitations
Keeping EDs in mind as a differential will help you pick up cases earlier
Patients with EDs are unlikely to present complaining of disordered eating… in
fact a study has shown, people suffering with an ED attend their GPs
frequently with other presenting complaints prior to diagnosis
What questions should you ask to explore the possibility
of an ED diagnosis?
Five simple questions can give you a good starting point for
questioning:
1. Do you make yourself Sick because you feel uncomfortably
full?
2. Do you worry you have lost Control over how much you eat?
3. Have you recently lost more than One stone in weight
(7.7kg)?
4. Do you believe yourself to be Fat when others say you are
thin?
5. Would you say that Food dominates your life?
Two or more positive answers indicate further questioning and
examination BUT do not rely solely on these questions to determine
whether or not people might have an ED
SCOFF#
Questionnaire# •Have you set yourself strict rules around food?
•How do you feel about social events involving food?
•Do you feel you are less spontaneous with social situations?
•Do you find yourself lying to people about the amount of food you eat?
•Do you find yourself thinking about food most of the day?
•Do you find that you are indecisive and spend excessive amounts of time in
supermarkets looking at food?
•Do you have feelings of guilt after eating certain foods?
•Do you feel like you have a constant internal battle with yourself when it
comes to deciding what to eat?
•How often do you weigh yourself and how does it make you feel?
•Do you find yourself trying to falsely justify your food decisions e.g. saying
you don’t like something when you do?
•Do you find that you don’t seem to laugh or have fun anymore?
If)you)think)the)patient)may)be)suffering)from)AN)or)BN,)these)questions)can)
be)used)to)explore)the)diagnosis)further….
EDs#are#not#just#about#
the#food,#they#affect#all#
aspects#of#a#patient’s#life#
Other things to explore:
•Family support and history of EDs
•Occupation
•Relationships
•Exercise
Gastro-Oesophageal
Reflux
Red)Flags)
•Hypothermia#
•BMI#below#safe#range#
•<40#bpm#or#postural#tachycardia
•Hypotension##(may#be#orthostatic)#
•Failure#of#Sit#up#–Squat#–Stand##
•Prolonged#QTC#>450ms#
Lucy#Hines#-June#2020# Lucy#Hines#-June#2020#
Lucy#Hines#-June#2020#
Lucy#Hines#-June#2020#
Lucy#Hines#-June#2020#
Lucy#Hines#-June#2020#
Lucy#Hines#-June#2020#Lucy#Hines#-June#2020#
6
Fractures due to
reduced bone density
