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Clinical features

Core psychopathology

• Fear of normal body weight
• Pursuit of thinness
• Body dissatisfaction
• Self-evaluation solely in terms of weight and shape
• Body image distortion.

General psychopathology

• Depression
• Anxiety
• oCD symptoms
• Paranoid ideation
• Suicidal ideation
• Social isolation
• Cognitive impairment.

Behavioural features

• 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.

Physical complications

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

Co-morbidity is seen in 50% of cases, with co-morbid depressive disorders, anxiety disorders, substance misuse, PTSD, and personality disorder being common.

Source

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