These materials were provided for the support program, organized, and conducted on a volunteer basis by the Association of Doctors and Psychologists “Eating Disorders: Therapy and Prevention” and by a team of psychologists from Patrick’s Mental Health Services (Dublin, Ireland).
We express our deep gratitude to colleagues who led and supported this project:
St Patrick’s Mental Health Services (SPMHS), Dublin, Ireland.
Psychology Department:
- Adj Prof Clodagh Dowling, Director of Psychology at SPMHS & Adj Prof at the School of Psychology, University College Dublin (UCD)
- Dr. Clíona Hallissey Clinical Psychologist, SPMHS
- Dr. Marion Mernagh Clinical Psychologist, SPMHS
- Lizzy O’ Brien, Assistant Psychologist, SPMHS
The Psychology Department from SPMHS would like to thank and acknowledge Dr Ken Goss Consultant, Psychologist and founder/ developer of CFT-E for all his support, mentorship and generosity.
Communications Department:
- Sinéad Makk, Communications Manager, SPMHS
- Katie Crosby, Communications Officer, SPMHS
- Tamara Nolan, Director of Communications, SPMHS
Association of Doctors and Psychologists: “Eating Disorders: Therapy and Prevention”
- Tetyana Nazarenko: psychologist, psychotherapist, chairman of the board of the Association
- Dr Maryna Fatieieva, psychologist, PhD
Marina Svētiņa: nutritionist, Children’s clinical university hospital of Riga (Latvia)
Translator:
- Kateryna Chudnenko: psychologist and psychotherapist from St Patrick’s Mental Health Services.
EATING DISORDERS
ASSESSMENT PROTOCOL
Note it may be helpful to do this questionnaire with both parents/ caregivers and the young person. If possible please meet them together and separately.
Name of the young person:
Name of parent/caregiver(s) present at the assessment (if not a parent please specify the relationship the caregiver has with the young person)
Date of Birth:
Address:
Gender:
Current Living Situation where and who with?:
- Location:
- Setting (e.g. private accommodation, host family, hotel/hostel etc.):
- Who are you living with (name their relationship with you e.g. sister, mother etc.):
Family Composition: (or Who is in your immediate family? (feel free to do a genogram if that is helpful)
General Practioner/Local Doctor contact details:
Assessor:
Key tasks of interview:
□ Symptom Assessment
□ Risk Assessment \ Risk Management Plan.
□ Make treatment recommendations based on need, motivation, severity and supports
Give out questionnaires (name the specific questionnaires to give out here)
Administer the following measures to young people:
- SCORE-15
- Eating Questionnaire-A (EDE-A)
- Revised Children’s Anxiety and Depression Scale (RCADS)
- Strengths and Difficulties Questionnaire (SDQ) S11-17/ Strengths and Difficulties Questionnaire (SDQ) S18+
Administer the following measures to parents:
- Revised Children’s Anxiety and Depression Scale – Parent (RCADS-P)
- Strengths and Difficulties Questionnaire (SDQ) S11-17/ Strengths and Difficulties Questionnaire (SDQ) S18+
- SCORE-15
Orientation and Motivation
□ How do you feel about being here today? Whose idea was it that you come? Who was most keen on you coming?
□ What thoughts do you have (if any) about what you want to get out of this appointment?
Current Eating Disorder Symptoms
□ Please describe the things that you (or the person who wanted you to come) are finding difficult at the moment.
Eating Disorder Symptoms
| Eating Disorder Symptom | Duration & Frequency | Details |
| Food restriction Calories/Portion sizes No. of episodes/spacing Skipping meals |
| |
| Foods avoided/excluded Fear, intolerance Moral choice | ||
| Fluid overload to avoid eating |
| |
| Fluid restriction Amount drunk |
| |
| Bingeing Objective Subjective Binge foods | ||
| Vomiting Voluntary Involuntary | ||
| Chewing and spitting out food \ regurgitation | ||
| Drugs for weight loss Laxatives Cigarettes Other |
| |
| Exercise Type/amount
| ||
| Eating speed & other rituals
|
| |
| Mirror/body checking
|
| |
| Weighing |
| |
| Problems with buying food \ preparing & cooking food | ||
| Social difficulties related to food \ size shape | ||
| If female: Menstruating
|
Eating Disorder Symptom History
□ When did these difficulties begin? (PROMPTS – Did any stressful events occur around this time, i.e. trauma, negative feedback about weight/body image? If not sometimes positive feedback can also be a trigger for example someone commenting on accidental weight loss, did this ever happen to you?
Any illnesses/physical conditions around this time that led to weight loss?)
□ What ideas do you, or other people, have about how these difficulties developed?
□ Have these difficulties changed over time?
(PROMPT: Explore significant changes in symptom presentation, age, & brief explanation for changes)
□ Has anyone else had worries about eating or body size and shape in the family? Explore more- who, how do you know, did they get treatment?
□ Does the young person relate to any of the following predisposing feelings and behaviours? (add more detail below if you wish)
- An anxious temperament prior to the development of an eating disorder.
- High Threat Sensitivity; hypervigilance e.g. looking for threats
- Perfectionism/obsessive compulsive traits e.g. wanting things a certain way
- Low Tolerance of Uncertainty: liking to know what is happening next
- Inflexibility; finding it hard when things change
- Harm Avoidance e.g. avoiding things that may lead you to feel uncomfortable
- Alexithymia e.g. not knowing how you feel
- Low Tolerance of Negative Emotions. Finding it hard to feel upset/ distressed
Weight History & Current Weight
□ Have there been any changes in your weight over the last 12 months? Who noticed this first?
□ Have there been any changes in your weight over the last month?
(PROMPT: Has client’s weight been stable, or have they gained or lost weight over last 12 months, how much/how quickly, include unintentional weight loss/gain & reasons i.e. illness/medication)
□ Do you feel comfortable knowing your current weight?
□ Client weighed at screening and height taken.
BMI = (Weight in kilograms) + (Height in metres x Height in metres)
Height: Weight: BMI:
□ Is this a weight you feel happy with or do you feel over or underweight? Would anyone at home disagree/ agree?
Physical Health and Well-being
□ Have you noticed any physical symptoms associated with your eating disorder and/or any other physical health concerns for example low energy, stomach problems ? Is anyone else worried about your health? Who? What would they say?
□ Are you and the above issues being monitored by your GP/doctor ? Have you had any tests or treatment for these physical health difficulties related to your eating difficulties?
□ IF FEMALE: Do you currently have regular menstrual periods?
□ Do you have any other physical difficulties/problems?
Mental Health Risk Assessment
□ Explore current Psychiatric Co-Morbidity (e.g. depression, anxiety etc- please also refer to the questionnaires completed by the young person ).
□ If you were emotionally upset what would you do? (PROMPT – ask for a specific memory)
If you were physically sick/ unwell what would you do? (PROMPT – ask for a specific memory)
□ Do you take any drugs? (please specify what and amount)
Do you consume any alcohol? (please specify approx amount)
□ Risk of harm to self or others
(PROMPTs: Including self-harm, reckless behaviours, suicidal ideation, planning, intent, previous suicide attempts, protective factors)
(PROMPT: Physical or verbal aggression to others; eating disorder behaviours) (if suicidal what would you do?)
□ Current Risk Management
(PROMPT: How does the person typically respond to stressful events, are there any stressful events foreseeable in the near future, what plans (if any) do they have to cope with these? Does the person have insight into risk? Who supports them in managing current risks?
Treatment History
□ Have you ever had treatment for your eating difficulties before?
(PROMPT: Ask them to describe when (e.g. approximate date), with whom (what type of service), length of each episode)
□ What was helpful/unhelpful in your previous treatment(s)?
□ Have you had any treatment for any other mental health difficulties i.e. depression/anxiety? (What type of treatment (e.g. medication/therapy etc), when, how long did this treatment last for?)
Personal History
□ Current circumstances
(PROMPT: Ask about accommodation status, home life, family relationships, for parents/ caregivers ask about employment status, finances)
□ What happens when people disagree at home? who are you most like at home? who are you closest to- why is that? Who are you least close to- why is that?
□ Family/social history:
(PROMPT: Ask about important life events, trauma, separations & loss)
□ Education History
(PROMPT- where and when they started primary and secondary school, any transitions/changes to schooling, are they currently attending a school? How do they get on in school? (academically and socially))
Patterns, Triggers and Consequences
Have you noticed anything that is likely to make your difficulties worse (what guarantees that you would restrict, binge, purge, worry about your shape etc)?
(PROMPT: explore events, relationships, interpersonal conflict, problematic feelings, separations/losses, thoughts etc What happened after you started losing weight? i.e. feeling less anxious, positive feedback from the environment, feeling more in control, etc. Hold in mind the impact of the ED on the family as a whole: Parent and Child Anxiety (Inc splitting), guilt/blame leading to anger, feeling controlled helpless, feeling overwhelmed/reduction in ability to mentalise (family tension ++), Interactions rigid+, withdrawal/negotiation, accommodation of AN.
□ Is there anything that you or people around you could do that has ever helped you to reduce or stop your eating disorder behaviour? (PROMPT- for any eating disorder behaviours they have already mentioned)
□ Thinking back over the difficulties that you have described; have there been any costs of having your eating disorder that have affected your life? If no, check if anyone at home would see this differently? What would they say?
□ Have there been any costs of having your eating disorder that have affected the lives of the people close to you? if no, would you think anyone else would disagree with you? what would they think?
□ Do you want to work on moving on from your eating difficulties?
□ Does anything concern you about working on your eating difficulties at present?
Support Networks
□ Do you have friends? How often are you in contact with them?
□ Who knows about your difficulties?
□ Does anyone else need to know about your difficulties and would anything stop you from telling them?
□ What hobbies or activities do you like doing?
Additional Information
□ Is there anything else in your life that you are finding upsetting or difficult to manage in addition to your difficulties around eating that you feel it is important we know about?
□ Is there anything that would stop you accessing treatment (e.g. uncertainty, safety)?
□ Is there anything you want to ask us (or anything you want to tell us that you would have expected us to ask about)?
Mini Meal
If you have concerns about the young person engaging in psychological intervention please ask them to eat a mini snack in front of you at the end of the assessmentand observe how they get on.
- Does the young person eat the snack?
- What did you observe?
- If a parent/guardian was present how did they respond?
The mini meal is not a routine intervention and should be used only when warranted by the clinical condition of the child i.e. when the child is seriously unwell, possibly becoming medically unstable and if s/he is unable to eat.
Mini meal (coined “milk and biscuit test” by our paediatrician) is to test out the possibility of avoiding a hospital admission by restarting eating during the assessment feedback. The therapist needs a clear contingency plan in case the child does not eat (including checking the availability of paediatric beds should an admission be needed). This should always be congruent with the specific clinical situation and any additional action be clearly seen as a consequence of the child being unable to eat and the increased risk that this entails. This may require asking the family to return to the clinic the following day for further medical review and monitoring or that an immediate paediatric admission is necessary.