CRS - Anorexia Nervosa

Explanation

Alice’s weight loss is most likely caused by reduced dietary intake following her initial illness with gastroenteritis. However, Alice’s GP will also need to clarify the details of the initial episode of gastroenteritis. What evidence is there from the history that this was infective gastroenteritis? Has Alice had any other similar episodes? Are there details from the history to help exclude the possibility that Alice’s continuing weight loss is secondary to inflammatory bowel disease? Is there any possibility that Alice may have a malabsorption disorder such as coeliac disease due to gluten intolerance? Has Alice had polydipsia, polyphagia and polyuria suggesting the onset of Type 1 diabetes? Are there any signs other than weight loss that fit with the possibility of hyperthyroidism? It will be important to establish Alice’s current pattern of intake and expenditure. This may be difficult, particularly at this first interview about it. There may also be a place for a food diary but this may be difficult for someone with an eating disorder to truthfully complete. People with eating disorders may also expend energy in very unusual ways. Information about this may not always be elicited with the usual questions the GP would use. Some patients with eating disorders wake during the night to exercise by, for example, jumping rope or skipping in place in their room, unbeknownst to other family members. They may disguise that they are walking longer distances than previously or attending multiple exercise classes and then continuing to exercise at home. Specific questions related to eating disorders are another area that may be difficult to broach at the initial interview. Patients may deny using aperients, or laxatives, diuretics and appetite suppressants, or techniques such as inducing vomiting. Information regarding body image may also be revealed at later interviews. Beginning with a preliminary HEADSS psychosocial assessment, including any thoughts of self-harm is an excellent way to begin.