Common Psychiatry Histories - Eating Disorders

Question 1

Key questions to ask in a suspected eating disorder
-history of PC

PATIENT IS UNLIKELY TO GIVE YOU INFO UNLESS YOU ASK

Answer 1

Onset

Duration

Past episodes of disordered eating

Previous and current weight and height

• thoughts about weight
• frequency of weighing

Eating

• current and past patterns
• no of meals
• amounts eaten
• past Hx of dieting
• specific foods avoided

Compensation
-binging, purging, laxative use, exercise?

Body image perception

• how do you feel about your body
• do you spend a lot of time body checking
• Do you avoid eating with other people?
• Do you find yourself eating a lot of food very quickly to the point where you feel extremely full and embarassed?

Question 2

Systems review

Answer 2

Mood screen

Risk screen

Physical health
CV
-SOB, fatigue, cold all the time
-palpitations

GI
-constipated, bloating

MSK
-muscle cramps, weakness

Question 3

Past medical history, drug history, family history

Answer 3

Past physical health

Past mental health support

Drug history
-use of laxatives

Family history
-mental, physical health

Question 4

Social history

Answer 4

Living

• who’s at home with you
• any dependents, carers
• relatives thought on eating patterns

Occupation

• in work?
• impact of eating
• use of exercise to burn off calories

Substances
-smoking, recdrugs, alcohol

Question 5

Anorexia vs bulimia vs binge eating

-core features

Answer 5

AN
Restrictive eating => physical impacts
Compensating for food eaten
Overwhelming fear of gaining weight

BN
Recurrent episodes of binge eating with a lack of control
-can be to the point of being uncomfortably full
-shame and guilt
Compensating for food eaten
Overwhelming fear of gaining weight

BED
Recurrent episodes of binge eating with a lack of control
-can be to the point of being uncomfortably full
-shame and guilt

Question 6

Body dysmorphic disorder

Answer 6

Excessive worry over a specific body part
Frequent body checking
Attempts to conceal flaws

TO A POINT WHERE DAILY LIFE IS AFFECTED

Question 7

Risk factors for eating disorders

Answer 7

FHx

Perfectionism
Anxiety disorder
Body image dissatisfaction
Teased, bullied

Question 8

Investigations for eating disorders

Answer 8

BMI
Blood glucose

FBC, U&E, LFT - anemia, electrolyte derangements
Bone profile - risk of osteoporosis in HA
Reproductive hormone bloods - HA

Question 9

Management for eating disorders

Answer 9

Mental

• CBT,
• addressing other mental health conditions (depression, anxiety)

Physical
-dietician support to improve nutritional status