Key Components of the History of Present Illness (HPI) for Eating Disorder Patients
A comprehensive History of Present Illness (HPI) for a patient with an eating disorder should include detailed assessment of eating patterns and behaviors, compensatory behaviors, weight history, body image concerns, medical symptoms, and psychosocial factors that may contribute to or result from the disorder. 1
Essential Elements of the HPI
Eating Patterns and Behaviors
- Detailed description of current eating patterns
- Presence of binge eating episodes (defined as eating a larger amount of food within a 2-hour period compared to peers with a perceived lack of control) 1
- Frequency of binges (at least once weekly to meet diagnostic threshold) 1
- Associated features of binges:
- Eating faster than normal
- Eating until uncomfortably full
- Eating large amounts when not physically hungry
- Eating alone due to embarrassment
- Feeling distressed, guilty, or depressed after eating 1
- Restrictive eating patterns
- Changes in appetite
- Food avoidance behaviors
Compensatory Behaviors
- Presence and frequency of purging behaviors (vomiting, laxative use, diuretic use)
- Exercise patterns (frequency, intensity, compulsive nature)
- Fasting behaviors
- Use of diet pills or other weight loss supplements
- For patients with diabetes: insulin manipulation 1
Weight and Body Image History
- Weight history (highest and lowest adult weights, recent weight changes)
- Weight loss goals and methods
- Body image concerns and disturbances
- Fear of weight gain 1
- Perception of current body size and shape
Medical Symptoms
- Gastrointestinal symptoms (abdominal pain, bloating, constipation)
- Cardiovascular symptoms (palpitations, chest pain, syncope) 2
- Menstrual history for females (amenorrhea, irregular periods)
- Weakness, fatigue, dizziness
- Sleep disturbances
- Dental problems
- Cold intolerance
Psychiatric and Psychosocial Assessment
- Screening for co-occurring psychiatric disorders (depression, anxiety) 1
- Suicidal ideation or self-harm behaviors
- Substance use
- Impact on social functioning, relationships, and daily activities
- Stressors that may have precipitated or exacerbated the eating disorder
Treatment History
- Previous diagnoses related to eating disorders
- Previous treatments and responses
- Current treatments
- Hospitalizations related to eating disorder complications 1
Family History
- Family history of eating disorders
- Family history of other psychiatric disorders
- Family history of obesity, diabetes, or other weight-related conditions 1
- Family dynamics around food, eating, and body image
Important Clinical Considerations
- Use the DSM-5 criteria to ensure consistent assessment of eating disorders 1
- Differentiate between eating disorder types (anorexia nervosa, bulimia nervosa, binge eating disorder, ARFID) based on specific patterns 1
- Screen all patients with unexplained weight loss or appetite changes for eating disorders 1
- Pay special attention to patients with diabetes who have unexplained hyperglycemia and weight loss 1
- Document vital signs, height, weight, and BMI calculations as part of the initial evaluation 1
Common Pitfalls to Avoid
- Focusing solely on weight rather than on eating behaviors and psychological aspects
- Failing to screen for medical complications that may require immediate intervention
- Overlooking psychiatric comorbidities that may complicate treatment
- Not assessing for electrolyte abnormalities in patients who purge, which can lead to serious complications including cardiac arrhythmias 1
- Neglecting to evaluate cognitive function in patients who purge frequently, as this can affect their ability to drive safely 1
- Focusing only on the primary eating disorder without addressing related health concerns
By systematically addressing these components in the HPI, clinicians can ensure comprehensive assessment of patients with eating disorders, leading to appropriate diagnosis and treatment planning.