Topics to cover when assessing the eating problem

Table 5.1 from Fairburn CG, Cognitive Behavior Therapy and Eating Disorders, Guilford Press, New York, 2008.

  Topics to cover when assessing the eating problem.

Current state of the eating problem (over the past four weeks and three months)

  • Patient’s account of the problem and what he/she would like to change
  • Eating habits on a typical day (and, if applicable, a “good” and “bad” day)
  • Dieting
  • Dietary restraint (nature of attempts to restrict food intake): dietary rules; reaction to any breaking of these rules; calorie counting; calorie limits; delayed eating (i.e., postponing eating for as long as possible)
  • Dietary restriction (actual under-eating)
  • Other weight-control behavior (e.g., self-induced vomiting, laxative or diuretic misuse, over-exercising): frequency; relationship to perceived overeating
  • Episodes of overeating (amount eaten and the context; whether or not there was a sense of loss of control at the time): frequency; triggers
  • Other eating habits (picking, chewing and spitting, rumination, ritualistic eating)
  • Drinking and smoking habits (consumption of water, coffee, tea, carbonated drinks and alcoholic beverages, and smoking habits – and their connection (if any) to the eating problem)
  • Social eating: ability to eat with others; eating out
  • Concerns about shape and weight
  • Views on shape and weight
  • Importance of shape and weight in self-evaluation
  • Body checking (weighing, mirror use, other forms of checking); body avoidance
  • Comparisons with others
  • Feeling fat
  • Impact of the eating problem on psychological and social functioning
  • Effects on mood and concentration
  • Effects on work
  • Effects on other people (partner, family, friends, acquaintances)
  • Effects on activities and interests
  • Other effects

Development of the eating problem

  • Details of onset and likely triggers
  • Subsequent sequence of events (when the key forms of behavior started in relation to each other): evolution of the problem – first six months; subsequently
  • Weight history (before and since the eating problem started; true childhood obesity): lowest weight since present height; highest weight since present height

  • Prior treatment (for an eating or weight problem): treatment-seeking; treatments offered; treatment experience and attitude to treatment; compliance with treatments and response to them

Personal and family history

  • Where born and brought up
  • Family during childhood (parents, siblings, atmosphere, disruptions and/or problems) and contact at present
  • School, college and occupational history
  • Interpersonal history – childhood/adolescent/adult interpersonal functioning
  • Family psychiatric history (especially depression and alcohol abuse)
  • Family eating disorder and obesity history
  • Adverse events (including physical and sexual abuse, bereavements, accidents, bullying and teasing)
  • Personal psychiatric history (especially anxiety disorders, depression, perfectionism, low self-esteem, self-harm, substance misuse): onset in relation to the onset of the eating problem; interactions

 

Current circumstances and functioning

  • Living arrangements
  • Occupation
  • Marital status, children
  • Contact with family
  • Interpersonal functioning (partner, family, confidantes, friends, gregariousness)
  • Past interpersonal functioning (and since eating problem developed)
  • Interests and aptitudes
  • Past interests and aptitudes (and since the eating disorder developed)

 

Co-existing psychopathology

  • Current psychiatric comorbidity (depression, anxiety disorders, substance misuse, self-harm, suicidal behavior, other)
  • Current psychiatric treatment (psychological, pharmacological)

 

Physical health

  • Current physical health (including menstruation)
  • General medical history (including timing of puberty in relation to the eating problem)
  • Current medication including the contraceptive pill

 

Attitude to the eating problem and its treatment

  • Views on what is keeping the eating problem going
  • Attitude to starting treatment
  • Concerns about treatment and the prospect of change
  • Goals

Anything else?

“Is there anything else that you would like to tell me, or anything else you think I should know?”

Published on Jun 15 2016