Anorexia Nervosa – Diagnostic Interview
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Read our comprehensive review on Anorexia Nervosa – Neurobiology, Diagnosis and Management
OPEN QUESTIONS
Patients are usually guarded and establishing rapport is crucial. They may minimise symptoms. It is essential to maintain a high index of suspicion.
- Take me through a normal day.
- What do you eat at breakfast, lunch, dinner?
- What do you think about your meal intake?
MORBID FEAR OF FATNESS
- Are you concerned about your weight?
- What do you do to prevent putting on weight?
- Are you afraid of gaining weight?
- What is your height? How much do you weigh? (BMI = kg/m2)
BODY IMAGE DISTURBANCE
- What do you see when you look in the mirror?
- What is your ideal weight?
- Here is a piece of paper. Can you draw an outline of what you look like now and what you would like to look like?
SELF INDUCED WEIGHT LOSS
- How do you lose weight/prevent putting weight on? Sometimes people may use other ways of losing weight such as exercise, thyroid supplements, fat burners or laxatives (Normalising statement to assist with information gathering)
COMPLICATIONS
- Sometimes people, who lose weight rapidly or have below normal body weight may have medical problems. Have you had any medical issues recently?
- Have you recently been admitted to hospital …? For fractures, fainting, dizziness, chest pain?
- How have your menstrual periods been lately? (Not necessary as a criterion in DSM-5 but still retained for diagnosis in ICD-10)
IMPORTANT POINTS IN CLINICAL PRACTICE
- Keep a high index of suspicion for medical compromise. Hence always examine pulse, BP and request blood tests for electrolytes including Magnesium, Phosphate, Calcium and Zinc
- Physical examination is a must
- Request an ECG is cardiovascular compromise is suspected
- Low pulse and BP with ECG abnormalities may require a hospital admission.
- Beware of the risk of re-feeding syndrome with electrolyte abnormalities
- Family history may reveal genetic predisposition to eating disorder
- Perfectionistic traits are highly associated with Anorexia Nervosa
MEASURES OF SEVERITY AND TYPES OF ANOREXIA NERVOSA
- Mild: BMI >=17 kg/m2
- Moderate: BMI 16-16.99 kg/m2
- Severe: BMI 15-15.99 kg/m2
- Extreme: BMI < 15 kg/m2
Restricting type:
- During the last three months, the individual has not engaged in recurrent episodes of binge eating or purging behaviour (i.e. self-induced vomiting, or the misuse of laxatives, diuretics, or enemas). This subtype describes presentations in which weight loss is accomplished primarily through dieting, fasting and/or excessive exercise.
Binge-eating/purging type:
- During the last three months, the individual has engaged in recurrent episodes of binge eating or purging behaviour (i.e. self-induced vomiting, or the misuse of laxatives, diuretics, or enemas
INIDCATIONS OF HIGH MEDICAL RISK AND INPATIENT TREATMENT
Weight
- BMI <14 kg/m² or rapid weight loss (adults) or <75% of
expected bodyweight or rapid weight loss (adolescents)
Medical status
- Heart rate <50 bpm
Cardiac arrhythmia
Postural tachycardia (increase >20 bpm)
Blood pressure <80/50 mm Hg
Postural hypotension >20 mm Hg
QTc >450 ms
Temperature <35·5°C
Hypokalaemia <3·0 mmol/L
Neutropenia
Phosphate <0·5 mmol/L
Additional indicators
- Severe bingeing and purging (eg, several times daily)
Failure to respond to outpatient or day-patient treatment
Severe psychiatric comorbidity
Suicidality
Read our comprehensive review on Anorexia Nervosa – Neurobiology, Diagnosis and Management
References
American Psychiatric Association: Desk Reference to the Diagnostic Criteria From DSM-5.Arlington, VA, American Psychiatric Association, 2013
ICD-10 Classification of Mental and Behavioural Disorders
Hay P, Chinn D, Forbes D, et al, and the Royal Australian and
New Zealand College of Psychiatrists. Royal Australian and
New Zealand College of Psychiatrists clinical practice guidelines
for the treatment of eating disorders. Aust N Z J Psychiatry 2014;
48: 977–1008.