Eating Disorders



These guidelines have been produced to guide clinical decision making for general practitioners (GPs). They are not strict protocols. Clinical common-sense should be applied at all times. These clinical guidelines should never be relied on as a substitute for proper assessment with respect to the particular circumstances of each case and the needs of each patient. Clinicians should also consider the local skill level available and their local area policies before following any guideline.


If a patient is experiencing severe physiological or psychiatric instability with imminent risk to self or others, please refer to the nearest Emergency Department


Many psychological disorders and physical illnesses experienced by children and adolescents (young people) involve disordered eating. One third of all adolescents have experienced dissatisfaction with their body weight or had unhealthy weight control practices1.Up to 41% of adolescent females experienced disordered eating1.

Eating disorders are highly complex, serious mental illnesses with significant physical complications and psychosocial impairment. The early identification and treatment of an eating disorder is essential for a positive prognosis. Treatment should be provided in a stepped-care approach, with young people and their families stepping up to more intensive care, or back down to less intensive care, as indicated5.

Services for children and adolescents presenting with eating disorders are delivered across multiple settings, including Community Child and Adolescent Mental Health Service (CAMHS), Perth Children’s Hospital Emergency Department (PCH ED), PCH Adolescent Medicine (Ward 4A) and the CAMHS Eating Disorder Service (EDS).

The CAMHS EDS is a Tier 4 state-wide specialist service, offering assessment to young people up to 16 years of age with severe eating disorders including:

  • Anorexia Nervosa
  • Bulimia Nervosa
  • Atypical Anorexia Nervosa
  • Binge Eating Disorder
  • Avoidant Restrictive Food Intake Disorder (ARFID - if high school-aged)
  • Eating Disorders Not Otherwise Specified (EDNOS)

To ensure a patient is accepted into this service, please demonstrate that Tier 1-3 services have been insufficient, or are unlikely to succeed. The outcome of an assessment may be to offer treatment with EDS, and if indicated can continue to be accessed up to 18 years of age.

A four-tiered pyramid chart explaining the mental health tiered system of care

Figure 1: The mental health tiered system of care


Pre-referral investigations

  • Thorough history taking including:
  • Seemingly unrelated psychological and physical complaints e.g. stress, depression, anxiety, menstrual irregularities, dizziness
  • Exploration of body dysmorphia/over-evaluation of weight/shape
  • Evidence of weight controlling behaviours (restriction, exercise, purging) including duration, frequency, severity
  • Gastrointestinal symptoms including abdominal pain, nausea, vomiting, constipation & food intolerance
  • General Medical Examination including:
  • Cardiovascular
  • Respiratory
  • Abdominal
  • Neurological
  • Dermatological

  • Assessment of physiological compromise (see Figure 2 for admission indicators):
  • Postural instability: pulse & BP on lying and standing after 1 minute
  • Temperature
  • Weight, Height and BMI
  • Useful blood tests:
  • FBC
  • U&E
  • LFT
  • BGL (random)
  • Urinalysis
  • Iron studies
  • IGF1
  • B12, folate, Vitamin D
  • Calcium, Magnesium, Phosphate
  • Hormonal testing-TFT, FSH, LH, oestradiol, prolactin
  • ECG including measurement of corrected QTc interval
  • Results of any recent imaging studies

See ‘Physical Health Form’ in the Useful Resources Section below as a guide when reviewing a patient


Discuss with Adolescent Consultant

Moderate risk
Weekly review

Risk   High concern  Significant concern Moderate concern
 % median BMI  <70% >70  80%  >80  90%
 Recent weight loss over
3 consecutive weeks
 >1kg / week  0.5 – 1kg / week   <0.5kg / week
 Awake heart rate (HR) <45 beats / min <50 beats / min  50–60 beats / min
 Postural change  >50 >30  
 Rhythm Any arrhythmia
ST or T-wave change
 Syncope Recurrent Occasional Pre syncope
 Blood pressure (BP) <80 / 40 < 90 / 50  
 Postural systolic BP fall 20mmHg 15mmHg <15mmHG
 QTc ms >450    
 Oedema Present    
 Tympanic temperature <35.5°C    
 Extremities Cold / blue /
pressure sores present
 Dehydration Moderate – severe  Mild  

Significant electrolyte disturbance
Hypoglycaemia <3.0 mmol/L
Hypokalaemia <3.0 mmol/L
Hypophospataemia <0.9 mmol/L


 Acute food refusal 3 days <50% of required  50% of required
 Purging / vomiting After all intake Multiple times per day  
 Behaviour relating to
 meal support and limits
 Violent Unable to implement meal plan  
 Activity / exercise Uncontained 
 Self-harm Overdose Active self-harm  
 Suicidality Moderate to high Low level suicidal ideation  
 Other mental health
Psychosis, confusion, delirium,
cognitive slowing
Obsessive Compulsive Disorder,

Figure 2: Indicators for admission. Criteria adapted from the RANZCP (2014) and NSW (2014) Guidelines4, 5

Pre-referral management

Please see the management and referral pathways for patients outlined in these documents:

Other useful resources for management:

When to refer

<16 years of age with significant physiological instability

  • Promptly contact the PCH Adolescent Medical On-Call Consultant Paediatrician via PCH Switchboard to formulate a plan regarding need for assessment and/or admission

Significant psychiatric instability with non-imminent concerns about risk:

16-18 years of age with significant physiological instability:

How to refer

Essential information to include in your referral

  • Name and details of patient and caregiver, including hospital (UMRN) number and Medicare number if known
  • Current therapeutic engagement: provider/s and duration
  • Current medication (including any allergies)
  • Results of any investigations
  • Clear documented evidence of: 
    • significant weight concerns (or restrictive diet if ARFID) and,
    • significant physical sequelae of weight loss, and
    • of body image distortions (or restrictive diet if ARFID)
  • maximum weight with dates & minimum weight with dates (to enable estimation of rate of change)
  • Demonstrate that Tiers 1-3 have been insufficient or why they are unlikely to succeed due to the complexity of the patient’s situation, or the family’s inability to access Tier 2-3 services (e.g. for financial reasons)

Useful resources


  1. Sparti, C., Santomauro, D., Cruwys, T., Burgess, P., Harris, M. (2019). Disordered eating among Australian adolescents: Prevalence, functioning, and help received. International Journal of Eating Disorders, 52: 246254, doi: 10.1002/eat.23032
  2. Telethon (2015) Second Australian Child and Adolescent Survey of Mental Health and Wellbeing
  3. Hay P, Current approach to eating disorders: a clinical update, Internal Medicine Journal 50 (2020) 24–29
  4. Van Eaden, A et al, Incidence, prevalence and mortality of anorexia nervosa and bulimia nervosa, Curr Opin Psychiatry (2021) 34:515–524
  5. National Eating Disorders Collaboration Developing Practical Approaches to Eating Disorders, 2013

Adolescent Medicine & Child and Adolescent Mental Health Service-Eating Disorders

Last reviewed: Nov 2022

Review date: Nov 2025

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