In putting the self-assessment together, we hope to help you and your family doctor decide what level of care might be best for your needs at this time. This can save you time waiting for treatment–we don’t want you to wait months to receive treatment, only to be told you were referred to the wrong level of care!

In the treatment of eating disorders, people can receive care either in an outpatient setting where they are seen weekly or in a more intensive setting where they are seen multiple times a week and are monitored more closely for medical stability. By completing this self-assessment, you will be given a recommendation for a level of care that is likely to be appropriate for you at this time. However, you and your doctor will have to make the final decision together.

DISCLAIMER:

The following self-assessment tool is designed for individuals 16 years of age and older. Please be advised that survey questions and criteria indicating a specific level of care recommendation are not suitable for use in pediatric populations. If you are under 16 years of age, please consult your primary care provider for guidance when seeking treatment for an eating disorder.

Level of care recommendations from the self-assessment do not replace clinical judgment. Please remember that eating disorder symptoms change - so if your symptoms change, your recommendation may also change. Once you are referred, you will be assessed by the eating disorder program, and they may have different recommendations.

Before starting the self-assessment, we encourage participants to prepare themselves emotionally. Although unintended, we recognize that the following survey questions and topics have the potential to elicit uncomfortable and possibly triggering emotions. For example, in this survey, you will be asked questions about weight, symptoms, mood, and patterns of behaviour that might cause you harm. 

If you are experiencing distress, you may choose to stop the survey at any time. If you would like to start the survey again later, you may do so once you are ready.

If you are struggling and need immediate mental health crisis support, please visit
Crisis Services Canada or call their toll-free number +1 (833) 456 - 4566.

If you need immediate medical support, please visit your nearest emergency department, or call 911 as soon as possible.

Once you have completed the self-assessment a copy of your response will be emailed to you. Your email address will be used to send you a copy of your responses.

If you prefer to not provide your email, you can choose to do so. However, you will NOT be able to access a copy of your responses and recommendations once you complete the assessment.

Your responses will be kept strictly confidential and collected data will be reported anonymously and in aggregate for quality improvement purposes.

By completing this self-assessment, you are confirming that you consent to these conditions.

Why is this Question Asked?

If your eating disorder symptoms have been severe enough to require hospitalization in the last three months, a more intensive level of treatment than what can be provided in an outpatient setting is recommended.

Why is this question asked?

This brief questionnaire assesses depression. If you are struggling with depression, it can make it very difficult for you to be successful in treatment for your eating disorder. We would strongly recommend that you speak to your family physician about the difficulties you are having with your mood. Your doctor can speak to you about medication options and/or refer you for psychological treatment. There are some very effective options available online for the treatment of depression. We will provide you with a few resources in the recommendations section at the end of the survey.

If your depression is interfering with your functioning in your everyday life, this suggests you might also have difficulty making changes in the treatment of your eating disorder. We strongly recommend you speak to your physician about treatment options for your depression.

Why is this question asked?

When you are underweight, the body's overall metabolism slows. One consequence of this is that your heart rate can drop below 50 beats per minute (bpm). As your heart rate drops into this range, the risk of your heart stopping (i.e., cardiac arrest) is greater – particularly at night when your heart rate drops even further. The risk of a low heart rate can be worsened by the presence of other eating disorder symptoms, particularly symptoms that result in low potassium (e.g., vomiting, or use of laxatives and/or diuretics).

Why is this question asked?

Many eating disorder symptoms increase the risk to both you and your baby when you are pregnant. In addition to seeking treatment in a more intensive setting (e.g., day or inpatient programs), your doctor may recommend that you be followed by an obstetrician for a high-risk pregnancy.

Why is this question asked?

Body Mass Index (BMI) is a ratio of your weight to height. While it is not a perfect measure of risk, we do know that as people’s BMI drops below 16, their risk of medical complications related to being underweight increases greatly. When determining what intensity of eating disorders treatment to seek; we consider your BMI along with other risk factors.

Why is this question asked?

When we are considering your medical risk, we take into account what has been happening to your weight over the past few months.

Why is this question asked?

Binge eating can be part of many eating disorders – it can be present in anorexia nervosa, and is by definition part of bulimia nervosa and binge eating disorder.

Why is this question asked?

To keep your body's metabolism running smoothly, people ideally should aim to eat breakfast within an hour of waking and consistently consume food every 2 to 4 hours until they go to bed. When you don't eat throughout the day (i.e., fast), the body's ability to function normally is significantly compromised. When fasting is combined with other risk factors (such as purging), it can greatly increase your medical risk.

Why is this question asked?

For the body to repair itself after activity, adequate nourishment, or energy from food, is required. If you overtrain and/or undereat, you will run out of energy. Your body will then turn to the protein in your muscles, for the energy it needs. All people who overtrain are at greater risk for injury of muscles and joints. But the greatest concern is if you are both underweight and overtraining. Your heart can already be weakened because you are underweight, and overtraining places your heart under additional stress. This risk can increase even more if you are engaging in other eating disorder symptoms (e.g., purging).

Why is this question asked?

Frequent purging by vomiting can lead to dehydration, which leads to weakened muscles, fatigue, and electrolyte imbalances. Any activity that causes your body to lose fluids (such as vomiting) can lead to low potassium (also known as 'hypokalemia') - which is very dangerous. In the body, potassium helps regulate fluid balance, muscle contractions, and nerve signals. The most important muscle in your body is your heart. If potassium levels go too low, this can cause heart arrhythmias (or an irregular heartbeat) and heart failure. This is one way people can die from an eating disorder.

Why is this question asked?

Frequent purging by laxatives and/or diuretics can lead to dehydration which leads to weakened muscles, fatigue, and electrolyte imbalances. Any activity that causes your body to lose fluids (such as using laxatives and/or diuretics) can lead to low potassium (also known as 'hypokalemia') - which is very dangerous. In the body, potassium helps regulate fluid balance, muscle contractions, and nerve signals. The most important muscle in your body is your heart. If potassium levels go too low, this can cause heart arrhythmias (or an irregular heartbeat) and heart failure. This is one way people can die from an eating disorder. Importantly, neither use of laxatives nor diuretics allow the body to get rid of the food you have eaten or lose weight.

Why is this question asked?

Research shows that people with type I diabetes are more likely to experience disordered eating.

Why is this question asked?

The regular use of substances can:

1. increase the medical risk associated with your eating disorder;
2. interfere with your eating (e.g., suppress appetite or cause binge eating); or
3. make it more difficult to participate effectively in the treatment of your eating disorder.

For all of these reasons, we recommend you talk to your physician about treatment for substance use. If you are not sure whether your substance use is problematic or could interfere with treatment for your eating disorder, we recommend you look into one of the substance treatment options provided in the recommendations section at the end of the survey. Some of these options are “low barrier”, do not require a referral to a treatment program, and are designed to help you decide if you do have a reason to be concerned about your substance use.

Why is this question asked?

If you've attempted suicide in the past, it suggests that at some point in your life, things were extremely difficult for you. You may have already addressed the issues that put you at risk. However, for some people, the things that put them at risk for attempting suicide have not yet been resolved. If you feel that you are still at risk and need help for something like depression, trauma, emotion regulation, or other factors, we recommend that you speak to your doctor about getting help for these issues.

Why is this question asked?

Some of the individuals use self-harm as a way of managing difficult emotions. Some know that if their eating disorder symptoms were to decrease, their self-harm behaviors would increase. When the self-harm behaviors are frequent or have needed medical attention, we find that people do much better in treatment for their eating disorder if they have already received treatment to help them manage difficult emotions using skills – for example, through dialectical behavior therapy (DBT). If this is the case, we strongly recommend that you and your family physician look into DBT treatment options.

Why is this question asked?

You cannot be completely sure you will be able to make changes to your eating until you try.

 If your medical risk is low enough that outpatient treatment is indicated, we suggest you try treatment at this level of care first – even if you feel you could benefit from daily support. Outpatient treatment allows you to recover in your home while maintaining other aspects of your life like school, work, or time with your family. If you can sustainably interrupt eating disorder behaviours in the context of your normal life, you can be more confident that you will sustain recovery after treatment.

 If your medical risk is such that you have been told you can choose between outpatient or more intensive treatment , your insight about the support you think you will need to make changes plays a key role. If you believe you will need daily support to make changes, please feel free to choose treatment at the higher level of care rather than outpatient treatment.

 If your medical risk is high enough that a referral to a higher level of care is indicated, we suggest you pursue treatment from more intensive programs - even if you feel you can make changes without daily support. Your risk is high enough that we would want you to have close medical supervision and the necessary amount of support to help keep you safe.

Before submitting your self-assessment, we would like to know if you are interested in participating in future research opportunities. Please note that this would be completely voluntary and does not impact your ability to access our services.