Key Components of the History of Present Illness for Eating Disorder Patients
The History of Present Illness (HPI) for a patient with an eating disorder should include a comprehensive assessment of eating patterns and behaviors, compensatory behaviors, weight history, body image concerns, psychological symptoms, and medical complications.
Essential Components of the HPI
Eating Patterns and Behaviors
- Document specific eating disorder behaviors 1:
- Binge eating episodes (frequency, duration, amount of food consumed)
- Definition of binges: eating larger amounts of food within a 2-hour period compared to peers with perceived lack of control
- Associated features of binges: eating faster than normal, eating until uncomfortably full, eating large amounts when not hungry, eating alone due to embarrassment
- Restrictive eating patterns (types of food restrictions, caloric intake)
- Meal skipping or food avoidance behaviors
- Changes in appetite
Compensatory Behaviors
- Document any compensatory behaviors 1:
- Purging behaviors (self-induced vomiting, frequency)
- Laxative, diuretic, or diet pill use (type, frequency, amount)
- Excessive exercise patterns (type, duration, frequency, compulsive nature)
- Insulin manipulation in patients with diabetes
Weight and Body Image History
- Detailed weight history 1:
- Current weight and BMI
- Highest and lowest adult weights
- Recent weight changes (amount, timeframe)
- Weight goals and perception of ideal weight
- Body image concerns and distortions
- Fear of weight gain
Psychological Assessment
- Document psychological symptoms 1:
- Feelings of distress, guilt, or depression after eating
- Anxiety related to food or eating situations
- Impact on daily functioning and quality of life
- Suicidal ideation or self-harm behaviors
- Previous psychiatric diagnoses or treatments
Medical Symptoms and Complications
- Document any medical symptoms related to the eating disorder 1, 2:
- Gastrointestinal symptoms (abdominal pain, bloating, constipation)
- Cardiovascular symptoms (chest pain, palpitations, syncope)
- Menstrual irregularities in females
- Fatigue, weakness, dizziness
- Sleep disturbances
- Cold intolerance
Treatment History
- Previous treatments and responses 1:
- Prior diagnoses of eating disorders
- Previous hospitalizations
- Past outpatient treatments (types of therapy, medications)
- Effectiveness of previous interventions
Family History
- Family history relevant to eating disorders 1:
- Family members with eating disorders
- Family history of other psychiatric conditions
- Family dynamics around food and eating
- Family history of obesity or weight concerns
Clinical Pearls and Pitfalls
Avoid focusing solely on weight as the primary indicator of eating disorder severity; behavioral patterns and psychological distress are equally important 1, 3
Screen for co-occurring psychiatric disorders such as depression and anxiety, which are common in patients with eating disorders and may affect presentation and treatment 1
Ask specifically about compensatory behaviors to distinguish between different types of eating disorders (e.g., bulimia nervosa vs. binge eating disorder) 1
Assess for medical complications that may require urgent intervention, such as electrolyte abnormalities in patients who purge frequently 1, 2
Use non-judgmental, empathetic language when discussing eating behaviors, as patients may feel shame or embarrassment about their symptoms
Document frequency and patterns of disordered eating behaviors, as diagnostic criteria often include specific thresholds (e.g., binge eating occurring at least once weekly) 1
By systematically addressing these components in the HPI, clinicians can ensure comprehensive assessment that guides appropriate diagnosis and treatment planning for patients with eating disorders.