A 24-year-old man presents to your clinic with a 6-month history of fatigue.

This patient has clinical signs of an eating disorder — fatigue, low BMI, hypotension, and hypokalemia — likely secondary to nutritional deficiencies or purging. The first step is to sensitively explore the patient's perception of weight and body image. Effective management requires rapport and careful conversation.

Toronto Notes 2023 – Psychiatry, Eating Disorders:

“Approach patients with suspected eating disorders non-judgmentally. Begin with permission to discuss weight or body image. Screening tools like SCOFF can help guide further assessment.”

MCCQE1 Objectives – Psychiatry > Eating Disorders:

“Candidates must recognize signs of eating disorders and initiate a respectful and effective patient-centered discussion.”

Referring to the ED (B) is not urgent without hemodynamic instability. Advising caloric intake (C) bypasses assessment. GI referral (D) is not appropriate at this stage.

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