Brooke Harbor Health System
PMHNP Clinical Learning Environment
Condition Guide
Eating-disorder assessment integrates psychiatric symptoms, eating and compensatory behaviors, growth or weight trajectory, vital signs, laboratory findings, medical symptoms, development, culture, function, and level-of-care needs. Avoid drawing conclusions from body size alone. Assess eating-related behaviors, nutritional and medical status, changes over time, functional impact, and psychiatric risk together.
Clinical application
Apply these prompts within the simulated clinical context. They support—but do not replace—clinical judgment, supervision, consultation, current guidance, local policy, law, or emergency procedures.
Diagnostic Features
DSM-5-TR diagnosis requires the complete syndrome, duration and exclusions; weight or a screening score alone is insufficient.
Restricted energy intake leads to significantly low weight for age, sex, development and health, with intense fear of weight gain or persistent behavior interfering with gain, plus disturbed body experience, undue influence of weight or shape, or limited recognition of seriousness.
Recurrent objectively large binge episodes with loss of control and recurrent inappropriate compensatory behavior occur at least weekly for three months; self-evaluation is unduly influenced by weight or shape, and episodes do not occur exclusively during anorexia nervosa.
Recurrent binge episodes include loss of control and at least three associated features, marked distress, and frequency of at least weekly for three months, without regular compensatory behavior or occurrence exclusively during bulimia or anorexia nervosa.
Avoidance or restriction causes weight or growth compromise, nutritional deficiency, supplement or enteral dependence, or marked psychosocial interference and is not explained by food scarcity, cultural practice, weight-shape concerns, or another condition alone.
Pica involves persistent eating of nonfood substances for at least one month. Rumination disorder involves repeated regurgitation for at least one month; each requires developmental, cultural, medical and other eating-disorder exclusions.
Use other specified feeding or eating disorder when clinically significant symptoms cause distress or impairment but a named disorder is not fully met and the reason is stated; use unspecified when the reason is not specified or information is insufficient.
Rating Scales & Screening
Select tools for the population and purpose, then verify every result clinically.
Five-question case-finding screen for possible anorexia nervosa or bulimia nervosa; a positive result requires further assessment.
View NICE screening guidance ↗Self-report measure of eating attitudes and behaviors with scoring and referral information from the instrument authors.
Open EAT-26 ↗EDE interview and EDE-Q self-report support detailed symptom measurement; confirm current permissions and version requirements.
Open CREDO instruments ↗The NIAS and PARDI-AR-Q can support assessment of avoidant/restrictive patterns but do not replace diagnostic and medical evaluation.
Open PARDI resources ↗Assessment
Use non-stigmatizing language and recognize that patients may minimize symptoms because of shame, fear, ambivalence, impaired insight, or prior weight stigma.
Assess restriction, fasting, binge episodes, vomiting, laxatives, diuretics, diet pills, insulin manipulation, compulsive movement, rituals, body checking, avoidance, and fluid intake.
Clarify sensory sensitivity, fear of aversive consequences, low interest, nutritional impact, growth or weight change, dependence on supplements, pica, and rumination behavior.
Assess dizziness, syncope, chest symptoms, weakness, cold intolerance, gastrointestinal symptoms, bleeding, dental effects, menstrual or endocrine change, injuries, seizures, and refeeding risk.
Assess depression, anxiety, OCD, trauma, neurodevelopmental conditions, substance use, self-harm, suicide risk, perfectionism, family context, bullying, stigma, and functional impairment.
Medical Risk
Level-of-care decisions require current medical and psychiatric information and access to an appropriately experienced team.
Review heart rate, blood pressure including orthostasis when indicated, temperature, hydration, weight trajectory, growth in youth, and focused findings rather than a single number.
Select CBC, metabolic studies, magnesium, phosphorus, glucose, hepatic, endocrine, pregnancy, urinalysis, ECG, or other testing according to behaviors, symptoms, and risk.
Urgent evaluation may be required for syncope, significant vital-sign abnormality, electrolyte disturbance, arrhythmia, severe dehydration, acute food refusal, uncontrolled purging, or high suicide risk.
Identify malnutrition and recent intake change, plan nutritional rehabilitation with an experienced team, and monitor fluid, electrolyte, cardiovascular, and neurologic complications.
Treatment
The plan should be diagnosis-specific, developmentally appropriate, and delivered at a level of care capable of managing current risk.
Use eating-disorder–focused psychotherapy. Options may include CBT-E, family-based treatment for youth, interpersonal approaches, and other structured treatments matched to diagnosis and context.
Restore adequate and consistent nutrition, interrupt dangerous behaviors, address food variety when relevant, and use a coordinated plan that avoids contradictory messages.
Medication may target specific eating disorders or co-occurring conditions, but it does not replace nutritional rehabilitation and psychotherapy. Consider malnutrition-related pharmacokinetic and safety issues.
With consent and developmental appropriateness, involve family or chosen supports in meal support, safety, monitoring, communication, and recovery while preserving patient dignity.
Follow-Up
Weight is only one data point and should never become the entire definition of progress.
Track restriction, bingeing, purging, compensatory movement, ritualization, avoidance, variety, meal consistency, and ability to use treatment skills.
Follow vital signs, symptoms, laboratory or ECG findings, hydration, endocrine and bone health, growth in youth, sleep, cognition, and physical function as indicated.
Assess mood, anxiety, OCD symptoms, trauma responses, self-harm, suicidality, substance use, social connection, school or work, and quality of life.
Identify early behavioral and medical warning signs, barriers to disclosure, support contacts, thresholds for added structure, and a rapid route back to treatment.
Clinical Sources
These sources support clinical reasoning but do not replace a complete assessment, current prescribing information, local policy, consultation, or individualized shared decision-making.
2023 evidence-based assessment and treatment recommendations.
Open source ↗Clinical recommendations for screening, evaluation, psychotherapy, and coordinated care.
Open source ↗Current FDA labeling for medication-specific indications, risks, and monitoring.
Open source ↗