Eating disorder history

• History of presenting complaint:

  • Weight history - SLIM
  • Eating behaviours
  • Adaptive behaviours
  • Physical symptoms including red flag symptoms
  • Psychological symptoms
• Weight history:

  • What was their weight at different stages of life?
  • Any periods of excessive or rapid weight loss? Any triggers for these?
  • What is their ideal weight? when were you most happy/sad about your weight? how do you currently feel about your weight?
  • What was your minimum and maximum weight?
• Eating behaviours:

  • Typical day's food intake
  • Do they think their eating habits are similar to friends and family?
  • Has anyone expressed concern about their food intake?
• Adaptive behaviours:

  • Exercise - how much and what kind
  • Purging - vomiting or medication use (consider insulin misuse if diabetic)
  • Binge eating - if there are triggers and how it makes them feel after
• Red flag features:

  • Rapid weight loss
  • Heart rate <40
  • Significant orthostatic BP changes (>20 mmHg)
  • History of recurrent syncope
  • ECG abnormalities
  • Fluid refusal or signs of severe dehydration - oliguria, tachypnoea, tachycardia, reduced skin turgor
  • Hypothermia
  • Signs of electrolyte disturbance
  • Unable to stand up from squatting or sit up from laying
• Psychological symptoms:

  • Explore mood - low mood, mania
  • Anxiety and panic attacks
  • Obsessions and compulsions
  • Risk - suicide, self harm, homicidal
• Systemic enquiry:

  • Neurological - memory, concentration, numbness/weakness, dizziness on standing
  • Respiratory - SOB particularly on exercise
  • Cardio - palpitations or chest pain
  • GI - changes to bowel habits, abdominal pain, reflux, bloating
  • GU - changes to urinary frequency, changes to or absence of menstruation
  • Skin - hair loss or growth, dry skin
• Explore the patient’s general social context including:

  • “Are you feeling particularly stressed at the moment in any area of your life?” (school, work, home)
  • “How are your eating habits impacting your family/relationship/friends?”
  • “Has anyone else commented on your mood or behaviours recently?”
  • “Have you spoken about your concerns to any friends/family/partner?”