- • Fear of normal body weight
- • Pursuit of thinness
- • Body dissatisfaction
- • Self-evaluation solely in terms of weight and shape
- • Body image distortion.
- • Depression
- • Anxiety
- • oCD symptoms
- • Paranoid ideation
- • Suicidal ideation
- • Social isolation
- • Cognitive impairment.
- • Calorific restriction (daily intake <1000 kcal/day)
- • Avoidance of ‘fattening’ foods
- • Prolonged fasting
- • Excessive exercise
- • Binge eating
- • Purging (e.g. self-induced vomiting, laxative misuse)
- • Excessive fluid intake
- • Food rituals (e.g. cutting food into small pieces, hiding food)
- • Substance misuse
- • Deliberate self-harm
- • Avoidance of treatment
- • Body-checking.
The range of physical complications seen in eating disorders is extensive, and knowledge of these is essential when assessing physical risk.
A screening assessment of physical risk should include a minimum of:
- • BMI = weight (kg)/height (m)2
- • Blood pressure, pulse, temperature
- • Tests of proximal myopathy (the stand-up/squat test)
- • Full blood count, urea and electrolytes, bicarbonate, phosphate, magnesium, calcium, glucose, thyroid function, and liver function
- • Electrocardiogram
- • Dual-energy X-ray absorptiometry (DEXA) scan.
Evaluation of physical risk should be seen as a longitudinal process, with medical monitoring being a cornerstone in longer-term care, alongside standard psychological and social interventions.
Co-morbidity is seen in 50% of cases, with co-morbid depressive disorders, anxiety disorders, substance misuse, PTSD, and personality disorder being common.