Clinical presentation

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ED are characterised by disturbances in eating behaviours and food intake that impair psychosocial functioning and/or physical health. This may involve:

  • Food restriction (e.g., limiting the amount of food eaten each day by reducing portion size, eliminating food types such as fats or carbohydrates, or not eating at all).
  • Vomiting and purging.
  • Overexercise.
  • Binge eating (i.e., consuming an objectively large amount of food in a short period of time, accompanied by a sense of feeling out of control).

The majority of the physical symptoms associated with ED are related to the effects of starvation, but are also due to effects of bingeing, purging, or overexercising [879]. People with ED, particularly bulimia nervosa, may show few outwards signs of their disorder [880], and any visible physical signs may be complicated by AOD use. For example, AOD use can influence features that are usually associated with the assessment of EDs, such as weight, appetite and food restriction [880]. Furthermore, people with an ED may experience eating-related symptoms which are similar to those associated with AOD use, such as cravings and patterns of compulsive use [24]. AOD workers should therefore endeavour to maintain a direct, non-judgemental approach during assessment, and seek to obtain as much additional information as possible (e.g., from family and/or friends with the client’s consent) [881]. The level of care required will be dependent on illness severity, the presence of any medical complications, dangerousness of behaviours, and any other psychiatric comorbidities (e.g., depression, anxiety) [882].

AOD workers should also be aware of the potential interplay between ED and AOD use, and keep this in mind when conducting assessments. There may be AOD use related to the ED; for example, the use of tobacco, stimulants, diet pills, laxatives, diuretics, or caffeine to control weight or supress appetite [883]. As such, assessment should include a focus on the use of AOD as a weight loss mechanism, as well as the role it may have in emotion regulation [884].