GPAtlas🧭 When to suspect
Suspect an eating disorder in anyone whose life is dominated by an excessive preoccupation with weight, shape and eating, driving dangerous weight-control behaviours.
• Classically an adolescent, but any age, sex or body weight.
• BMI alone neither confirms nor excludes the diagnosis: serious illness occurs at normal and raised weight.
• The risk is highest in young people aged 13–17.
Eating disorders carry the highest mortality of any psychiatric illness (through medical complications and suicide), yet there is on average a multi-year gap between first symptoms and treatment.
The job in primary care is to recognise early, assess medical risk, and refer without delay.
| Disorder | Defining pattern |
|---|---|
| Anorexia nervosa (AN) | • Restriction of intake leading to significantly low weight, intense fear of weight gain, and body-image disturbance • Restricting or binge–purge subtypes |
| Bulimia nervosa (BN) | • Recurrent binges with compensatory behaviours (vomiting, laxatives, fasting, over-exercise) • Weight is often normal, so it is easily missed |
| Binge eating disorder (BED) | • Recurrent binges with marked distress but no regular compensatory behaviour • Weight often raised • The commonest eating disorder |
| Other specified feeding or eating disorder (OSFED) | • Other specified feeding or eating disorder – clinically significant but not meeting full criteria (e.g. atypical anorexia at a normal weight) • Just as serious. |
| ARFID | • Avoidant/restrictive intake from sensory aversion, fear of an aversive consequence (e.g. choking), or low interest in food – not driven by weight/shape concern • Sits outside NG69 but still needs specialist assessment |
Be especially vigilant in leanness-focused activities (professional sport, dance, gymnastics, athletics, modelling), in type 1 diabetes (insulin omission), and where there is a family history of eating disorders or other mental illness.
Source: NICE NG69 · RCPsych MEED (CR233)
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