What is an appropriate History of Present Illness (HPI) for a patient with disordered eating habits?

From the Guidelines

An appropriate History of Present Illness (HPI) for disordered eating habits should include the onset, duration, and progression of symptoms, focusing on specific eating behaviors, weight changes, and psychological factors, as recommended by the American Psychiatric Association 1. When evaluating a patient with disordered eating habits, it is essential to document the patient's height and weight history, including maximum and minimum weight, and recent weight changes, as well as the presence of restrictive eating, food avoidance, binge eating, and other eating-related behaviors 1.

Key Components of HPI

• Presence of, patterns in, and changes in compensatory and other weight control behaviors, including dietary restriction, compulsive or driven exercise, purging behaviors, and use of medication to manipulate weight 1
• Percentage of time preoccupied with food, weight, and body shape 1
• Prior treatment and response to treatment for an eating disorder 1
• Psychosocial impairment secondary to eating or body image concerns or behaviors 1
• Family history of eating disorders, other psychiatric illnesses, and other medical conditions 1

Assessment and Documentation

Begin by documenting when the patient first noticed changes in their eating patterns, whether these developed gradually or suddenly, and any triggering events such as trauma, stress, or life changes 1. Detail specific behaviors like food restriction, binging, purging, excessive exercise, or use of laxatives/diuretics, noting their frequency and severity 1. Include information about weight history, body image concerns, and the patient's perception of their eating habits 1. Document associated symptoms like fatigue, dizziness, amenorrhea, dental problems, or gastrointestinal issues 1. Assess the impact on daily functioning, including social isolation, academic/work performance, and relationships 1. Note any previous treatments or interventions for eating disorders and their effectiveness 1. This comprehensive approach is essential because eating disorders have complex biological, psychological, and social components, requiring thorough documentation to establish appropriate diagnosis and treatment planning 1.

From the FDA Drug Label

The efficacy of Prozac was established in 8– to 16–week trials for adult outpatients with moderate to severe bulimia nervosa, i.e., at least 3 bulimic episodes per week for 6 months Bulimia NervosaProzac is indicated for the treatment of binge–eating and vomiting behaviors in patients with moderate to severe bulimia nervosa

An appropriate History of Present Illness (HPI) for a patient with disordered eating habits, specifically bulimia nervosa, should include information about the frequency and duration of binge-eating and vomiting behaviors, as well as any other symptoms related to the disorder. Key points to cover in the HPI include:

• Frequency of bulimic episodes per week
• Duration of symptoms (at least 6 months)
• Presence of other symptoms such as depression, anxiety, or obsessive-compulsive behaviors 2

From the Research

History of Present Illness (HPI) for Disordered Eating Habits

To construct an appropriate HPI for a patient with disordered eating habits, the following components should be considered:

• Chief complaint: The patient's primary concern or reason for seeking medical attention, which may be related to their eating habits or weight concerns 3, 4.
• History of present illness: A detailed account of the patient's eating habits, including the onset and duration of disordered eating behaviors, frequency and triggers of binge eating or purging, and any associated physical or emotional symptoms 3, 4.
• Past medical history: Any previous diagnoses or treatments for eating disorders, as well as any co-occurring medical or psychiatric conditions 3, 5, 6.
• Medications: A list of any current or past medications used to treat eating disorders or co-occurring conditions, including dosages and durations of use 3, 4, 6.

Key Components of HPI for Disordered Eating Habits

Some key components to include in the HPI are:

• Onset and duration of disordered eating behaviors
• Frequency and triggers of binge eating or purging
• Associated physical or emotional symptoms, such as weight changes, electrolyte abnormalities, or disturbances in reproductive hormones 3, 5
• Any previous treatments or hospitalizations for eating disorders
• Current medications and dosages

Considerations for HPI Construction

When constructing the HPI, consider the following:

• The patient's account of their eating habits and any associated symptoms should be thoroughly explored 4, 6.
• The HPI should be sensitive to the patient's potential for shame or secrecy surrounding their disordered eating behaviors 4, 6.
• The use of evidence-based assessment tools, such as the Eating Habits Questionnaire (EHQ), may be helpful in identifying and measuring eating disorders 7.