As a mental health provider, we hold significant influence in shaping our client’s understanding of health and body image. Yet eating disorders often go undetected, particularly when we rely on assumptions tied to weight and appearance. The truth? Eating disorders do not discriminate. They affect folks of any size, age, race, gender, or socioeconomic status. Whether you describe yourself as an eating disorder therapist or not, you have absolutely had a client with an eating disorder. Whether you continue to see this client, or refer them out because you feel it is beyond your scope, screening is crucial to getting clients the support they need. Keep reading to uncover our screening for eating disorders in primary care: 5 signs for therapists to start screening their clients for an eating disorder. Keep reading to discover how to screen for eating disorders, the importance of eating disorder screening, and specific signs or behaviors from clients that would warrant deeper screening and conversation.
When Should You Start Screening?
So back to the million dollar question, when should you start screening for eating disorders as a therapist? The simple answer- As soon as you the client ends up on your schedule. Even before you physically meet with them, having screening questions in your intake forms can be helpful in screening for an eating disorder. It is important to screen everyone, even those who might not “look” like they have an eating disorder. When screening, it’s important to screen through a weight neutral lens. This helps to make sure no one gets left out of the conversation. Formal screening tools tend to focus on individuals who are underweight. But folks in larger bodies are also at risk. And not just for binge eating disorder. This does not mean screening tools are all bad, but they might not tell you the whole story. In this blog, we will dive a bit deeper into the importance of eating disorder screening and go over some specific signs or behaviors from clients that would warrant deeper screening and conversation.
1. If your client expresses body dissatisfaction or fear of weight gain
If a client is making constant negative comments about their body and expressing dissatisfaction, this could be a sign that they will soon take action on these thoughts or comments (if they haven’t already). A client might not comment on their dissatisfaction with their body, but if you notice them constantly wearing big, baggy clothing in an attempt to hide their body, this could also be a sign of body distress. We don’t expect every client to love their body, but if the negative comments are frequent, or the client really hones in on them, it could be a sign that something deeper is going on.
2. If your client makes drastic changes in eating habits or exercise patterns
Changes in behaviors around food and exercise or excessive focus on either of these things are definitely something to assess further and get curious about. Asking open ended questions is a good way to get more information on how the client is feeling about their behavior changes. Are the behavior changes sustainable or are they causing more stress in the client’s life? What is their motivation to make these changes? If they are exercising, how open are they to taking rest days? Are their exercise behaviors age and developmentally appropriate? There is a fine line between exercise being beneficial to a client and it being a means of controlling their body.
3. If your client is experiencing physical symptoms that are not explained by other conditions
Eating disorders are a mental health diagnosis with physical manifestations. Common physical symptoms of eating disorders include but are not limited to: GI distress (bloating, constipation, reflux), missed menstrual cycles, dizziness, fatigue, cold intolerance, low heart rate, and weight changes. If a client is expressing physical symptoms that don’t seem to be improving with more medical based interventions, there is a chance these could be related to a client’s eating habits or their relationship with food. It is important that these symptoms not be blamed on food. And that clients of all body sizes be assessed when experiencing symptoms. Finding an eating disorder informed and HAES aligned doctor can be helpful in assessing these symptoms.
4. If your client has other mood and mental health concerns or diagnoses
Eating disorders tend to co-exist with other mental health conditions. And folks with other mental health conditions are at a higher predisposition for developing an eating disorder. In fact, up to 97% of individuals with an eating disorder are diagnosed with at least one other psychiatric condition during their lifetime. Diagnoses of anxiety, depression, OCD, ADHD, and trauma, along with many others, are commonly seen alongside eating disorder diagnoses. If your client has any of these diagnoses, it’s a good idea to get curious to see if these show up in ways related to food. Your client’s symptoms might not align exactly with those of an eating disorder diagnosis, but disordered eating patterns are concerning too. In screening, prevention is key. Appropriate screening can help your client get the support they need sooner rather than later.
5. If your client has a history of weight cycling or chronic dieting
Chronic dieting is a big predictor of eating disorders. And we unfortunately live in a society where this is common and encouraged. Just because something is common, does not mean it is normal. If your client has a history of dieting, using weight loss medications, or weight loss surgery, approach it with curiosity and not judgement. Ask them what their motivation for dieting is/was. Ask when they first started dieting or restricting food intake to change their body. Ask them about their relationship with food and their body. And about their loved ones’ relationships with food and body. It is not the client’s fault for wanting to change their body, and that doesn’t mean it is safe for them to be doing so.
How to Screen for an Eating Disorder
Below is a step-by-step, evidence-informed guide for clinicians on how to screen for eating disorders using a weight-neutral, compassionate approach. These steps are designed to support early identification, guide clinical decision-making, and help ensure clients receive appropriate, collaborative care.
Step 1: Start With a Treatment-Team Mindset
Before screening even begins, it’s important to approach eating disorder assessment with a treatment-team framework in mind. Eating disorders are complex biopsychosocial conditions, and effective care typically requires collaboration between mental health providers, medical providers, and registered dietitians. Screening is not about diagnosing or managing an eating disorder alone—it’s about identifying risk early and ensuring the client can access the appropriate level of support. Holding this mindset from the start helps guide ethical decision-making, referral timing, and scope of practice.
Step 2: Include Screening Questions in Your Intake Forms
Even before meeting your client, include neutral, open-ended questions about eating behaviors, body image, and attitudes toward food and movement in your intake paperwork. Examples include:
- “How do you feel about your relationship with food and your body?”
- “Have you ever tried to change your weight, shape, or eating habits?”
- “Do you experience distress around eating or exercise?”
Screening everyone—regardless of weight or appearance—ensures no one is missed.
Step 3: Observe Behavioral and Physical Signs
Throughout treatment, remain attentive to potential red flags, such as:
- Restrictive eating patterns, bingeing, or purging
- Frequent body dissatisfaction or negative self-talk
- Obsessive exercise or skipping rest days
- Physical symptoms such as fatigue, dizziness, GI distress, or missed periods
Document these observations for follow-up discussion.
Step 4: Ask Open-Ended Questions
When concerns arise, explore them with curiosity rather than judgment. Helpful questions include:
- “Can you tell me about your typical day around meals?”
- “How do you feel before, during, and after eating?”
- “What is your relationship like with your body right now?”
Your goal is to understand the client’s experience, not diagnose on the spot.
Step 5: Use Validated Screening Tools When Appropriate
Evidence-informed screening tools can help identify clients who may need further assessment, including:
- SCOFF Questionnaire – Five quick questions to flag potential eating disorders
- EDE-Q (Eating Disorder Examination Questionnaire) – More detailed assessment for ongoing monitoring
- ESP (Eating Symptom Profile) – Helpful for ARFID and less common presentations
Remember: tools are guides, not definitive diagnoses. Interpret results within the context of your clinical observations.
Step 6: Consider Risk Factors and Context
Screening should also account for known risk factors, including:
- History of dieting, weight cycling, or restrictive eating
- Co-occurring mental health conditions (anxiety, depression, OCD, ADHD, trauma)
- Participation in weight-focused sports or activities
- Family or cultural pressures around body image or food
Screening should always be framed with a weight-neutral and compassionate lens to avoid stigmatizing clients.
Step 7: Document and Plan Next Steps
After screening, clearly document concerns, patterns, and client responses. Determine next steps, such as:
- Can you safely continue treatment?
- Is a referral to an eating disorder-informed physician or dietitian necessary?
- What resources or psychoeducation might support the client?
Clear documentation and a referral plan ensure the client gets timely, appropriate support.
Final Thoughts: You Screened, So Now What?
Thank you for reading through our resource on how to screen for eating disorders as a clinician. If after your screening process, you are concerned that your client might have an eating disorder, what next? As a therapist, you’re in a unique and influential position. The rapport and relationship you have built with your client can be crucial in them getting the support they need. After expressing the concern to your client, the first step is forming a treatment team to get the client the support they need. You can start by having them go see a doctor, ideally a HAES aligned, eating disorder informed doctor, to get medically screened and ensure medical stability. The next step is referring them to an eating disorder dietitian for consistent support. These providers are not taking your place, but are joining you on the treatment team to help care for the client. After the screening, your job is not finished. This information could be shocking for your client to hear, and could also be new information. It is important to validate the client’s feelings about their body and help them process emotions from hearing your concerns. Remind your client that you are on their team, you are there to support them, to help them navigate these next steps.
References:
- National Eating Disorders Collaboration. Co-occurring conditions. NEDC website. Accessed January 14, 2026. (States: “Research demonstrates that 55-97% of people diagnosed with an eating disorder also receive a diagnosis for at least one more psychiatric disorder.”)
- Blinder BJ, Quintela AG, Ward PS, Agras WS. Psychiatric comorbidities of female inpatients with eating disorders. Psychosom Med. 2006 May-Jun;68(3):454-462. doi: 10.1097/01.psy.0000221254.77675.f5. PMID: 16738079. PubMed
- Patton GC, Selzer R, Coffey C, Carlin JB, Wolfe R. Onset of adolescent eating disorders: population based cohort study over 3 years. BMJ. 1999 Mar 20;318(7186):765-768. doi: 10.1136/bmj.318.7186.765. PMID: 10082698. Free full text (PMC)
- Morgan JF, Reid F, Lacey JH. The SCOFF questionnaire: assessment of a new screening tool for eating disorders. BMJ. 1999 Dec 4;319(7223):1467-1468. doi: 10.1136/bmj.319.7223.1467. PMID: 10582927. Free full text (BMJ)
- Cotton MA, Ball C, Robinson P. Four simple questions can help screen for eating disorders. J Gen Intern Med. 2003 Jan;18(1):53-56. doi: 10.1046/j.1525-1497.2003.20374.x. PMID: 12534764. Free full text (PMC)
- Golden NH, Schneider M, Wood C; Committee on Nutrition; Committee on Adolescence; Section on Obesity. Preventing Obesity and Eating Disorders in Adolescents. Pediatrics. 2016 Sep;138(3):e20161649. doi: 10.1542/peds.2016-1649. Epub 2016 Aug 22. PMID: 27550979. Free full text (AAP)
- Fairburn CG, Beglin SJ. Assessment of eating disorders: interview or self-report questionnaire? Int J Eat Disord. 1994 Dec;16(4):363-370. doi: 10.1002/1098-108X(199412)16:4<363::AID-EAT2260160405>3.0.CO;2-#. PubMed abstract
- National Institute of Mental Health. Eating Disorders: What You Need to Know. U.S. Department of Health and Human Services. Updated 2024.