Recognizing Anorexia Nervosa: PDF Worksheet, Tools and Exercises

In consultation, explaining the diagnostic logic of anorexia nervosa verbally often lands incompletely: patients and families nod, yet the three-pillar structure that distinguishes it from other clinical pictures rarely solidifies. This fiche PDF gives you a concrete visual scaffold to make that structure explicit in session, in a format the patient can take away and return to.

Why Anorexia Nervosa Is Hard to Explain at the Verbal Level

The diagnostic challenge with anorexia nervosa is not that the criteria are unknown to clinicians; it is that patients frequently meet two of the three pillars but resist identifying the third, or present features that blur into other diagnoses. Two confusions are particularly common in practice.

First, egosyntonic cognition. The fiche names this directly: "The danger of the low weight often isn't felt." When the patient lacks distress about low weight, the conversation stalls. Pointing to a visual representation of why that absence of insight is itself part of the picture, rather than evidence that nothing is wrong, shifts the register of the explanation.

Second, differential diagnosis. Clinicians working with restrictive eating presentations routinely face the dieting/ARFID/bulimia/depressive appetite loss confusion. An oral enumeration of differences is rarely retained. A side-by-side visual panel holds the distinctions in view while you discuss them.

What the Fiche Contains: a Three-Pillar Visual Framework

The fiche PDF organises the presentation across six numbered panels, structured so that the clinician can move through them in sequence or jump to the section most relevant to a given patient.

Panel 1 presents the three pillars as a diagnostic gate: all three must be present. Pillar 1 covers body weight thresholds (BMI under 18.5 for adults; BMI-for-age below the 5th percentile, or growth stasis, for children). Pillar 2 maps the full range of weight-maintenance behaviours, from restriction and purging to compulsive exercise, stimulant use, and insulin omission in diabetes, categories that patients often compartmentalise and do not spontaneously connect. Pillar 3 names weight-based self-worth as a structural feature, not a personality trait, including the observation that "fear of weight gain may never be spoken aloud, but shows in behaviour."

Panel 4 gives a concrete behavioural checklist for Pillar 3 (weighing repeatedly, calorie tracking, hiding under loose clothes, avoiding photos), which is clinically useful when the patient denies fear explicitly but endorses the behaviours.

Panel 5 covers the medical sequelae (cardiac, hormonal, digestive, dermatological, cognitive) and frames many of them as "effects of starvation itself, not personality", a reframe that can reduce shame and improve alliance when working alongside a GP or paediatrician.

Panel 6 handles the four most common look-alikes, including the crucial note that "you don't have to be extremely thin, vomit, or 'look ill' to be experiencing anorexia." This panel directly addresses the minimisation bias that delays both self-referral and family engagement. Clinicians working with perfectionism, low self-esteem, or body image disturbance will find the differential clear enough to quote directly to families.

> Key point: the fiche is a visual support that facilitates the explanation in session; it is not a self-administered screener. Its value lies in giving both clinician and patient something to look at together, building shared vocabulary before any therapeutic model is introduced.

When and How to Introduce the Fiche in Practice

This is an early-engagement tool, most useful in the first two or three sessions, before formulation work begins. It fits naturally after the anamnèse when you need to name what you are seeing without triggering defensiveness.

A low-pressure introduction might be: "I'd like to go through a short sheet with you that describes how this condition tends to show up. Some of it will fit your experience; some may not. Tell me what you recognise." That framing positions the fiche as a shared inquiry rather than a diagnostic verdict.

For adolescent presentations, the fiche is equally readable with parents in the room; the panel on physical consequences is particularly useful for communicating urgency to families who minimise severity. For clinicians using a CBT model of anorexia or bulimia further into the treatment, the fiche serves as a psychoeducation anchor to revisit when motivational ambivalence resurges.

Use the "To discuss in session" prompts at the end as a brief debrief structure: they address the "not bad enough yet" thought explicitly, which saves time when that cognition blocks engagement. For building the motivation conversation that follows, tools grounded in discrepancy building pair naturally with what the fiche opens up. Also worth integrating: an eating and energy levels resource for patients who frame restriction in performance or fatigue terms rather than weight terms.

The fiche does not replace clinical assessment or depression screening; it creates the shared language that makes both possible.

Sources

• American Psychiatric Association (2022). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). American Psychiatric Association Publishing.
• National Institute for Health and Care Excellence (NICE) (2017). Eating disorders: recognition and treatment (NICE guideline NG69).
• Herpertz-Dahlmann, B., van Elburg, A., Castro-Fornieles, J., Schmidt, U. (2015). ESCAP Expert Paper: New developments in the diagnosis and treatment of adolescent anorexia nervosa - a European perspective. European Child and Adolescent Psychiatry, 24(11), 1265-1283.