MOBILE VERSION

Assessing Disordered Eating Patterns Fraser Tait, University of Edinburgh Medical School

CONTENTS ?Who is at risk 3 ?How can I spot an ED 4 ?Are they binge eating 5 ?Are they restricting 5 ?Are they purging 6 ?Is their exercise excessive 6 ?Comorbidities 7 7 Do they meet diagnostic 8 9 ?criteria 10 11 ?IS THIS AN EMERGENCY 12 Impact on QoL Investigations Referral Resources

ksir? ta si ohW 6.4%Around of all adults display symptoms of disordered eating in their lifetime ,Due to a lack of presentation to general practice ( 'stigma of mental health particularly men s mental )health and poor understanding of disordered ,eating patterns by GPs data collected on EDs is .often underestimated -Eating disorders in masc presenting patients are chronically underdiagnosed due to the stigma of mental health conditions and a culture which ' ' .promotes a lean body ideal Eating disorders have the highest mortality rate 3 .of all psychiatric conditions ( )Binge Eating Disorder BED is often a missed / .diagnosis in overweight obese patients REMEMBER! ,Eating disorders are NOT isolated to skinny , -white femme presenting middle class - ,teenagers ANYONE regardless of their , .social background can have one

DE?) ( redrosid gnitae .This list is merely a suggestion If you have na tops I od woH ,clinical suspicion of an eating disorder .further investigation is always warranted Do they discuss a desire to lose 4 ?weight Have they recently begun a new ?diet Are there stressors for weight / ?loss gain ' -Does the patient s self description ?match your perception 'Does your patient s blood result reveal , , /anaemia low thyroid low red white ?cells Does your patient display signs of ?malnutrition Does your patient count / ?calories macronutrients

gnitae? REMEMBER! Binge Eating Disorder is often egnib yeht erA missed in those who present / 30.overweight obese and over :Does your patient Eat a large quantity of food in a ?discrete period of time Describe any emotional triggers ?related to this /Feel distressed during after ?meals Feel comfortable eating around ?others /Ever stop to answer the door phone ?during these episodes gnitcirtser? 5 yeht erA :Does your patient / ?skip miss meals ?avoid any foodstuffs ?describe recent weight loss ?Why is this /allergy medical condition fear of fatness negative sensory association

gnigrup? yeht erA Has your patient engaged in any of the following behaviours to avoid / ?weight gain aid weight loss -self induced vomiting laxative use thyroxine use enemas -consumed non food stuffs illicit drug use ( )excessive exercise see below evissecxe? 6 esicrexe rieht sI ?How often ?What time of the day 'How do they feel if they can t follow ?their exercise routine ?Do they take nutritional supplements ?Protein ?Anabolic steroids ?HGH How would they react if these ?became unavailable

:Is your patient seitidibromoC ?Pregnant - ?Insulin dependent diabetic ?Skipping insulin doses Have they ever had psychiatry input ?before Do they have a neurodevelopmental ?disorder 7 'If your patient doesn t meet airetirc? diagnostic criteria yet disordered citsongaid teem yeht oD ,eating patterns are clinically evident Other Specified Feeding or Eating ( ) .Disorder OSFED is a likely diagnosis ,However is there sufficient impact on ( )Quality of Life QoL to warrant ?specialist service involvement

EMERGENCY :Observations :ECG <40HR Bradycardia bpm >450QTc <35°Temp ms C -Non specific T wave Postural hypotension changes (or SBP <90) Hypokalaemic changes If your patient presents with any 8 ,of these features consider &emergency referral to A E for .medical assessment :Bloods <130 /Na mmol L :Examination BMI <13 <3.0 /K mmol L Muscle Raised transaminases weakness <3.0 /BM mmol L Raised urea and creatinine

How well can your patient LoQ no tcapmI undertake the following tasks on a 9 ?regular basis brush their teeth wash their whole body get dressed / /attend school college work complete assignments leave the house /laundry household chores reply to messages from /friends family concentrate on a task maintain a regular sleeping pattern :If your patient 3finds it difficult to maintain or more ,of these tasks or displays severe impairment 1 ,completing or more of these tasks This indicates an eating disorder causing /moderate severe impairment and .warrants specialist review

Physical examination snoitagitsevnI ' :Measure patient s 10 Height and weight calculate quantity of recent weight loss : , , 2,Obs BP HR SpO Resp Rate and Temperature :Bloods FBC &U Es LFTs Clotting Calcium : ,If BED fasting lipid profile fasting glucose and TFTs Urinalysis ECG

Does your patient meet the diagnostic larrefeR -10criteria for an eating disorder in ICD ?guidelines TNEGRU BMI <13 OR <15BMI with significant other risk factors indicating poor outcome <15BMI 11 YTIROIRP OR <18.5BMI with significant other risk factors indicating poor outcome OR insulin dependent diabetic pregnant ( )carer of young child ren ENITUOR All other circumstances Do not refer if EUPD is clinically , <18.5evident unless BMI or signifcant risk factors are present

Whether you have referred your patient or secruoseR ,not do not hesitate in making your patient .aware of the following resources TROPPUS NHS Online CBT Courses Cognitive Behavioural Therapy SISIRC BEAT website 12 Scottish Eating Disorder Interest ( )Group SEDIG website SEED Website : 0808 801 0677Beat helpline : 01482 718130SEED helpline : 0808 801Edinburgh Crisis Centre 0414 Mental Health Assessment Service ( ):MHAS 0131 286 8137 SPIT Want to skip a ?Wanting to purge Try ?meal Wanting to stopping yourself for ?binge Have a small , 15snack wait 1 , .even minute if you can -minutes and re .evaluate Keep extending the time .gradually The aim is to ,reduce gradually not .stop immediately

NHS LOTHIAN tinU sredrosiD gnitaE naihtoL SHN