Healthcare professionals are often missing signs of serious illness people with eating disorders due to a lack of training, the Royal College of Psychiatrists warns.

Launching its new Medical Emergencies in Eating Disorders guidance, the college said it could be hard to identify at-risk patients, as people with eating disorders could appear healthy, with normal blood tests, even when seriously ill.

Analysing NHS Digital hospital data for eating disorders in England, the college found evidence of increasing levels of hospital admissions, with 11,049 more admissions in 2020/2021 compared with 2015/2016.

Children and young people with eating disorders were the worst affected with a rise of 90% in the five-year period, from 3,541 to 6,713 episodes, with a 35.4% increase in the last year alone. There was also a stark rise of 128% in boys and young men — from 280 hospital admissions in 2015/16 to 637 in 2020/2021.

To aid decisions on emergency management, the new guidance contains an eating disorders risk assessment tool using a ‘traffic light’ system based on patient’s recent weight loss, BMI, and other measures such as blood pressure, hydration status and muscle strength.

In general, symptoms that should give rise to the suspicion of an eating disorder included unexplained changes in weight, restriction of diet (sometimes apparently for health reasons), binge eating, menstrual irregularity, vomiting, muscle weakness, abdominal symptoms, and changes in mood (irritability, anxiety or depression).

‘Patients with eating disorders can be deeply ashamed of their difficulties, while for others denial can be strong,’ the guidelines noted.

‘They may also be extremely scared about the consequences of sharing information about their difficulties – the thought of changing could feel too overwhelming or terrifying.’

Some people with eating disorders might also purge, the guideline stated, which could involve self-induced vomiting as well as laxative and diuretic abuse.

The resulting diarrhoea from laxative abuse caused loss of electrolytes, resulting in hypokalaemia, hypomagnesaemia and dehydration, the guideline noted.

‘Prolonged laxative abuse can cause colonic atony due to progressive weakness of the colonic muscle, and chronic constipation and rectal prolapse can follow, sometimes requiring colectomy,’ the document stated.

Diuretics could cause dehydration, hyponatraemia, hypokalaemia, and the reduced plasma volume may lead to an elevation in serum aldosterone levels.

‘Thus, when the diuretics are stopped, the patient can experience severe oedema, which can cause enormous anxiety in the context of intense body image concerns,’ the guidance noted.

Child and adolescent psychiatrist Dr Dasha Nicholls, who chaired the development of guidelines, said the college hoped to raise awareness around the symptoms of eating disorders, adding they did not discriminate and could affect people of any age and gender.

‘They are mental health disorders, not a ‘lifestyle choice’, and we shouldn’t underestimate how serious they are,’ she said.

‘Even though anorexia nervosa is often referred to as the deadliest mental health condition – most deaths are preventable with early treatment and support. Full recovery is possible, if spotted and treated, early.’

‘If we are to stop the eating disorders epidemic in its tracks, it’s vital that this guidance reaches healthcare professionals urgently and that government backs them with the necessary resources to implement them.’