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Name
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Emma Smith
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DOB
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12/01/2001 (17 years)
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Occupation
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College Student
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History
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I was brought in by her mother. She is worried that I am using things to help look after myself
[If pushed] I am looking after myself to lose weight. I am very proud of going from a size 14 to a size 8 because of how healthy I am feeling and looking. I have done so well in the last 6 months! "I can't be ill, I'm doing so well in school". I am aiming for A* in my A-level exams and I am doing very well. My mother doesn't know what a healthy diet is. It is important not to eat often and so I always tell my mum that I feel full. I refuse to open up about my diet, only stating that I eat very healthily. [Very reluctantly] Becomes angry and agitated when asked. "Please don't ask stupid questions." I have been unhappy with my looks since the age of 10. I always thought I was ugly, my friends just lie that I'm pretty to make me feel better. [If asked about laxatives directly] I got some laxatives from the pharmacy because the food I was eating wasn't coming out. It is only for constipation. I sometimes take a couple of doses a day until I'm getting it all out. [Physical symptoms] My periods have stopped. "It is ok, I checked - I'm not pregnant". Volleyball tires me out very quickly these days. She denies vomiting up any food or using any illicit drugs. She denies any recent episode of self-harm or any suicidal thoughts. Her mood is good, and she enjoys going to school. |
Past Medical History
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General anxiety as a teenager
Anaphylaxis (4 years ago) - unclear cause 1 episode of self-harm (cutting her arm) 6 years ago – but she regretted doing this |
Drug History
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None. Allergic to penicillin
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Family History
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None
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Social History
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Occasional cigarettes when hungry, no alcohol as that would be unhealthy.
Lives with mother, father and one younger brother in a five-bedroom house. Father runs a very successful business and mother is a primary school headteacher. She regularly goes out with friends and is the captain of the girls’ volleyball team. |
Introduction & consent
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Name, age, occupation
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Establishes duration of symptoms
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Establishes triggers/stressors/life events
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Explores pattern of eating disorder
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Explores eating habits
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Screens for vomiting and laxative abuse
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Screens for exercise and drug use
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Explores body image perception (body shape ideas, fear of fatness, perception of normal weight)
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Screens for episodes of bingeing
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Evidence of physical signs (cold, dizziness, weakness, thin hair)
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Endocrine dysfunction (amenorrhoea, libido)
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Explores views on consequences of behaviours
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Looks for risk to self including suicide
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Screens for Anxiety (feeling anxious, physical symptoms)
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Screens for depression (low mood, anergia, anhedonia)
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Explores impact on occupation or social life
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Explores available support
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Identifies level of insight and willingness to accept treatment
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Looks for substance misuse
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Previous medical & psychiatric history
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Family history of psychiatric or medical disorders
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Drug history, smoking and allergies
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Ideas "Was there anything you thought it might be?"
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Concerns "What about it is worrying you in particular?"
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Expectations "Is there anything in particular you were hoping we would to today?"
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Communication skills (empathy and avoids jargon)
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Summarises back to patient
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Gives reasonable differentials & discusses risk (Anorexia Nervosa, Body dysmorphia)
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