Identification & Initial Management of Eating Disorders

Clinical Features of Eating Disorders

Anorexia Nervosa
• Body mass index (BMI) i.e. weight in Kilograms divided by (height in metres) squared
< or = 17.5.
• Morbid fear or fatness.
• Amenorrhoea > 3 months.
• Distorted body image/self esteem unduly associated with weight and shape.

Bulimia Nervosa
• Episodes of over eating (binges).
• Recurrent compensatory behaviour (purging) e.g. vomiting, laxatives.
• Morbid fear or fatness.
• BMI usually within normal range (may be over or under).

Binge Eating Disorder
• Weight generally above normal limits.
• Eating larger amounts of food than normal within a discrete period of time.
• Sense of lack of control over eating during each episode.
• Marked distress in re-binge eating.
• Occurs at least twice per week for at least 6 months.
• Doesn’t meet bullimia criteria/doesn’t abuse meds to avoid weight gain.

Medical problems associated with eating disorders
• Depression.
• Deliberate self-harm & suicide.
• Cardiovascular e.g. arrhythmias, hypotension, cardiac failure.
• Osteoporosis.
• Erosion of dental enamel.
• Peptic ulcers.
• Gastric dilatation and delayed emptying.
• Elevated serum urea.
• Electrolyte imbalances.
• Constipation or diarrhoea.
• Hypothermia.
• Oedema.

The SCOFF Questionnaire - A Screening Tool For Eating Disorders
John F. Morgan, clinical research fellow,
Fiona Reid, lecturer in medical statistics,
J. Hubert Lacey, professor.

The SCOFF questions*
Do you make yourself Sick because you feel uncomfortably full?
Do you worry you have lost Control over how much you eat?
Have you recently lost more than One stone in a 3 month period?
Do you beleive yourself to be Fat when others say you are too thin?
Would you say Food dominates your life?
* One point for every “yes”; a score of 2 or more indicates a likely case of eating disorder.

Ref: Morgan J. F. (1999). British Medical Journal, 319: 1467.

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