History Questions and Physical Examination Findings in EDs

HistoryPhysical Examination Findings
Past medical historyAnorexia nervosa and other restrictive disorders
 Time course of weight loss, including minimum and maximum weight during adolescence. Sinus bradycardia
 Perceived goal weight/healthy weight Cardiac arrhythmias including QT prolongation
 Body image concerns Orthostatic changes in pulse >20 or blood pressure >10
 Dietary habits including 24-hr recall, history of restricting, binge eating, and/or purging Hypotension
 Exercise history Hypothermia
 Previous therapy Dry, pale skin
 Secretive behaviors Orange discoloration of skin
 Symptoms of systemic illnesses, such as inflammatory bowel disease, diabetes mellitus, celiac, lupus Lanugo
 Relevant review of systems: presyncope, syncope, headaches, fatigue, exercise intolerance, sleep disturbance, dry skin, increased shedding of hair/hair loss, cold intolerance, easy bruising, delayed wound healing, mood changes Bruising/abrasions over spine
Family history Acrocyanosis
 Eating disorders, obesity, depression, anxiety, alcoholism or drug abuse, bipolar affective disorder, schizophrenia Thinning scalp hair
Pubertal/menstrual history Facial wasting
 Menarche, last menstrual period, changes in regularity, duration Cachexia
 Timing of thelarche and pubarche if premenarchal Atrophic breasts
 Growth rate deceleration Scaphoid abdomen
 For males: history of decreased erections or nocturnal emissions Dependent edema
Social history Flat or anxious affect
 Recent stressors, family, school, friendsBN and other purging disorders
 Tobacco, alcohol, illicit drug use Sinus bradycardia or cardiac arrhythmias including QT prolongation
 History of physical or sexual abuse Orthostatic changes in pulse >20 or blood pressure >10
 Use of pro-eating disorder Web sites Callouses or abrasions over knuckles due to self-induced vomiting
 Mood changes Parotid enlargement
 Time with friends Dental enamel erosions, caries, oral ulcerations
 Engagement in fun activities Mood lability
 Recent stressors, family, school, friends Scleral hemorrhage
 Palatal petechiae
 Loss of gag reflex