Paeds · adolescent-and-young-adult-medicine
Eating disorders: recognition and medical instability
Also known as Anorexia nervosa · Bulimia nervosa · Binge-eating disorder · ARFID · Atypical anorexia nervosa · Refeeding syndrome risk · Medically unstable anorexia
A fellowship approach to recognising eating disorders in adolescents and deciding who is medically unstable: DSM-5 categories including anorexia, bulimia, binge-eating disorder and ARFID; SCOFF and HEEADSSS-based screening; physiological red flags and Junior MARSIPAN-style triage; focused assessment of weight, vital signs, posture and ECG; emergency stabilisation; and the threshold for admission — across ANZ, UK, US and Canada.
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Target exams
RACP General PaediatricsRACP DWERACP DCEMRCPCHABPRCPSC Pediatrics
Red flags
- Severe bradycardia (resting heart rate under about 40 bpm), especially with dizziness or syncope
- Hypotension under about 80/50 mmHg, or a marked postural rise in heart rate on standing
- Prolonged QTc, arrhythmia, or chest pain on ECG
- Hypothermia, cold peripheries and lanugo with rapid weight loss
- Biochemical instability — hypoglycaemia, low potassium, low phosphate, or dehydration
- Suicidal ideation, self-harm, or rapid weight loss with food refusal
Life stages
adolescentyoung-adult-transition
Care settings
outpatiented-acutewardcommunity-school
Clinical exam formats
written-onlyracp-dce-long-caseracp-dce-short-casemrcpch-history-managementmrcpch-communication
Board mappings
- Adolescent and Young Adult Medicine
- Eating disorders — recognition and medical instability
- Adolescent and Young Adult Medicine — DSM-5 eating disorder categories and atypical presentations
- Current 2026 PREP curriculum — Adolescent health: mental health and risk assessment
- Renewed curriculum for first-year trainees from 2027 — Learning goal 15: Essential general paediatrics
- Mental health in adolescence
- Medical instability and emergency stabilisation
- Long Cases — adolescent with weight loss and amenorrhoea
- Short Cases — cardiovascular and nutritional assessment
- Communication stations — engaging an ambivalent adolescent
- 11. Adolescent health
- Level 2: recognises eating disorders and assesses medical instability
- Mental health and behavioural problems
- Foundation of Practice (FOP)
- Applied Knowledge in Practice (AKP)
- Adolescent medicine and mental health
- History
- Communication
- Clinical
- General Pediatrics Content Outline — Domain 11: Adolescent Medicine
- General Pediatrics Content Outline — Domain: Mental health and eating disorders
- EPA: recognising and initially managing adolescent eating disorders
- Patient Care 1: History and Physical Examination
- Patient Care 5: Patient Management
- Systems-Based Practice: coordinating multidisciplinary mental-health care
- Medical Expert
- Collaborator
- Pediatrics: adolescent eating disorders and medical instability
References14ShowHide
- [1]Morgan JF; Reid F; Lacey JH The SCOFF questionnaire: assessment of a new screening tool for eating disorders. BMJ, 1999.PMID 10582927
- [2]Arcelus J; Mitchell AJ; Wales J; Nielsen S Mortality rates in patients with anorexia nervosa and other eating disorders. A meta-analysis of 36 studies. Archives of general psychiatry, 2011.PMID 21727255
- [3]Hay P; Chinn D; Forbes D; Madden S; Newton R; Sumer-Kallio J; Touyz S; Ward W Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of eating disorders. Australian and New Zealand journal of psychiatry, 2014.PMID 25351912
- [4]Golden NH; Katzman DK; Sawyer SM Update on the medical management of eating disorders in adolescents. Journal of adolescent health, 2015.PMID 25659201
- [5]Marikar D; Reynolds S; Moghrabi O; Dave M; Snook J; Harris J Junior MARSIPAN (Management of Really Sick Patients with Anorexia Nervosa). Archives of disease in childhood. Education and practice edition, 2016.PMID 26407730
- [6]Golden NH; Schneider M; Wood C Preventing Obesity and Eating Disorders in Adolescents. Pediatrics, 2016.PMID 27550979
- [7]Allison E; Nana M; O'Dea C; Spettigue W; Norris M Fifteen minute consultation: A structured approach to the management of children and adolescents with medically unstable anorexia nervosa. Archives of disease in childhood. Education and practice edition, 2017.PMID 28193620
- [8]Mountjoy M; Sundgot-Borgen J; Burke L; Ackerman KE; Blauwet C; Constantini N; Lebrun C; Lundy B; Melin A; Meyer N; Mountjoy M International Olympic Committee (IOC) Consensus Statement on Relative Energy Deficiency in Sport (RED-S): 2018 Update. International journal of sport nutrition and exercise metabolism, 2018.PMID 29771168
- [9]Golden NH; Katzman DK; Glasofer DR; Attia E; Yager J; Lynch T; Stryjecki C; Mensah J; Vaccaro J; Long M; Schek E; Mahr E; Kreipe HE Higher-Calorie Refeeding in Anorexia Nervosa: 1-Year Outcomes From a Randomized Controlled Trial. Pediatrics, 2021.PMID 33753542
- [10]Davidson KW, Barry MJ, Mangione CM, et al. Screening for Eating Disorders in Adolescents and Adults: US Preventive Services Task Force Recommendation Statement. JAMA, 2022.PMID 35289876
- [11]Peat CM; Huang S; Ranzenhofer LM; Cohen NR Addressing eating disorders in primary care: Understanding screening recommendations and opportunities to improve care. The International journal of eating disorders, 2022.PMID 35903970
- [12]Hartman-Munick SM; Silverstein S; Volpe-Krecker K; Zhang F; Hadland SE; Purtell N; Goncalves A; Richmond TK Association of the COVID-19 Pandemic With Adolescent and Young Adult Eating Disorder Care Volume. JAMA pediatrics, 2022.PMID 36342721
- [13]James RL; Khalsa S; Sharma A; Faruqi A; Sidiq M; Warnick J; Gallego J; Spettigue W; Norris MD; Katzman DK Physical health complications in children and young people with avoidant restrictive food intake disorder (ARFID): a systematic review and meta-analysis. BMJ paediatrics open, 2024.PMID 38977355
- [14]Trapani S; Mencaroni E; Rocchi A; Marciano C; Belli S; Di Donato M; Rigante D; Stagi S Medical Complications of Anorexia Nervosa. Pediatrics, 2025.PMID 40659363