GPAtlas🧭 When to suspect
Suspect an eating disorder in anyone – classically an adolescent, but any age, sex or body weight – whose life is dominated by an excessive preoccupation with weight, shape and eating, driving dangerous weight-control behaviours. The single most important principle is that BMI alone neither confirms nor excludes the diagnosis: serious illness occurs at normal and raised weight, and 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. |
| 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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