You are partway through a medical history form for weight care, and one line asks whether you have ever had, or been treated for, an eating disorder. Yours was bulimia nervosa. It took most of your twenties, and the last clinician you told about it was the one who treated you. You can answer that line deliberately rather than by flinching, once you know what a physician does with a yes, what a blank leaves them working from, and where the history itself gets looked at, which is somewhere other than here.
Write it down. A physician deciding about weight care is deciding about eating, and a history of disordered eating is the part of your record that bears on that most directly. The cost of saying it is worth naming plainly: a physician may decide that treatment is not appropriate for you. The cost of leaving it out is that a decision still gets made, without the one fact most likely to change it. And the history itself is treated somewhere else, by different people, whatever happens here.
What a history of an eating disorder changes for a physician
A history of an eating disorder changes what a physician has to weigh, because eating disorders are serious illnesses and the page records that people with eating disorders are at higher risk of medical complications and of co-occurring mental illnesses. A history is what makes that risk something a physician has to ask about rather than guess at.
Your weight will not carry it: people with eating disorders can be underweight, average weight, or overweight, and someone who appears healthy can be extremely ill. So a physician reading your chart has your measurements, your medicine list and your other conditions, and no route to this at all except the line you are looking at.
A yes does one more thing. Medical care and monitoring is one of the named parts of a treatment plan for an eating disorder, alongside psychotherapy, nutritional counseling and medication, and it is arranged by whoever is looking after you medically. It can only be arranged by someone who has been told there is a reason for it.
Writing it down, and leaving it out
Writing it down puts the history in front of the person making the decision, at the moment they make it. Leaving it out means the decision still gets made, on a record with a hole in exactly the place this belongs. Your doctor or provider needs to know what is really going on, so they can give you the care and treatments that would be best for you.
You still choose what goes where. A form has room for a yes and a rough date; the years behind it fit better in something you say to a person, and the yes is the part that has to arrive before the decision does. If improvising it in the room is the thing you are dreading, write one sentence in advance and read it out.
And the cost belongs beside the benefit rather than in a later paragraph: a physician may decide that treatment is not appropriate for you. A decision to decline, made by someone holding your history, is the outcome that line exists to make possible.
Where an evaluation happens, and how to get to one
An evaluation for an eating disorder happens outside weight care, and the way to one starts with a primary care provider. If you have concerns about your eating behavior or mental health, talk to a primary care provider, who can refer you to a qualified mental health professional such as a psychologist, psychiatrist or clinical social worker. You can ask for that referral this week, whatever you end up doing about the form.
Ask for that appointment by its name rather than in general terms. Treatment has three named parts:
- Psychotherapy, individual or group or family.
- Medical care and monitoring.
- Nutritional counseling.
A team of providers including doctors, nutritionists, nurses and therapists is the usual shape of that, and there are treatments that help.
If any of it is current rather than past, the order of the two appointments changes. Eating unusually large amounts of food in a short amount of time, throwing up, taking laxatives, exercising excessively and fasting are the named behaviors, and if you are doing any of them now, the call to a primary care provider is the one to make first. If you are struggling or having thoughts of suicide, call or text the 988 Suicide and Crisis Lifeline at 988, or chat at 988lifeline.org. In life-threatening situations, call 911.
Answering the line
- Put the yes on the form. A diagnosis and rough years is enough for a box.
- Write one sentence for the conversation: what it was, roughly when, what treatment you had, and whether any of it is current.
- Ask the physician directly what they do with that answer, and what it changes about what they can offer you.
- Book the other appointment separately. Call a primary care provider and ask for a referral to a mental health professional for an eating disorder.
- If any of it is current, make that call first.
A form is a poor instrument for a decade of anything, and this line is being asked to carry yours in a single field. It can still get the fact into the room where the decision is made, which is further than the fact travels sitting in your own head. A physician who reads it and says no has not wasted your appointment; that is the appointment working. The outcome worth avoiding is a yes given to a version of you that left this out.
