• Anorexia nervosa: restriction driven by fear of weight gain, body-image concerns, and often significantly low weight.
• ARFID (avoidant/restrictive food intake disorder): restriction not driven by weight or shape concerns. It may relate to sensory aversion to food textures or smells, fear of choking/vomiting, low appetite, or little interest in eating.
• OSFED: clinically serious restrictive symptoms that do not fit every criterion for a specific diagnosis.

• Fainting, collapse, confusion, seizure, or inability to stay awake
• Chest pain, a racing, irregular, or very slow heartbeat, or severe palpitations
• Severe shortness of breath
• Severe weakness, inability to stand/walk safely, or repeated near-fainting
• Signs of serious dehydration: very little or no urine, inability to keep fluids down, extreme thirst with marked dizziness, or persistent vomiting
• New swelling of feet/legs, rapidly worsening weakness, or severe muscle cramps
• Blood in vomit or stool
• Thoughts of suicide, self-harm, or being unable to stay safe

• Fainting, collapse, seizure, confusion, or extreme drowsiness
• Chest pain, severe breathlessness, or a fast, irregular, or unusually slow heartbeat
• Severe dizziness, especially inability to stand or walk safely
• Severe weakness, inability to keep fluids down, or very little urine
• Persistent vomiting, blood in vomit or stool, or severe abdominal pain
• Signs of low blood sugar such as shaking, sweating, confusion, or loss of consciousness
• Suicidal thoughts, self-harm, or inability to stay safe

• Indigestion or functional dyspepsia
• Gastritis, acid reflux, peptic ulcer disease, or H. pylori
• Slow stomach emptying (gastroparesis), especially with diabetes, nausea, vomiting, or bloating
• Constipation
• Medication effects, for example GLP-1 weight-loss/diabetes drugs, opioids, some antidepressants
• Pregnancy
• Anxiety or depression
• Less commonly, obstruction, abdominal fluid buildup, or cancer

1. Clarify the fullness pattern

• “Do you feel physically full after just a few bites, even though you want to eat?”
• “Is it fullness, nausea, pain, bloating, reflux, choking sensation, or fear of vomiting?”
• “Does food feel stuck when you swallow?”
• “Do you vomit, regurgitate, or feel nauseated after meals?”
• “When did this start? Is it getting worse?”
• “Is it worse with solids, liquids, or both?”
• “Any constipation, abdominal swelling, black stools, blood in vomit/stool, or jaundice?”

2. Ask directly about weight and body image

• “Are you trying to lose weight, avoid gaining weight, or prevent weight gain?”
• “Do you feel afraid of becoming overweight even when others say you have lost weight?”
• “How much does your weight or body shape affect how you feel about yourself?”
• “Do you believe you are larger than you are, or feel distressed by particular body areas?”
• “Are there foods you avoid because they feel ‘fattening’ or unsafe?”

3. Ask about restrictive and compensatory behaviors

• “How many meals and snacks do you usually have in a day?”
• “Do you skip meals, count calories, weigh food, follow food rules, or cut portions intentionally?”
• “Do you exercise to compensate for eating?”
• “Do you make yourself vomit or use laxatives, diuretics, diet pills, or fasting after eating?”
• “Do you ever binge or feel out of control with food?”
• “Do you hide eating habits or avoid eating with other people?”

4. Screen for ARFID-type restriction

• “Do you avoid food because of texture, smell, appearance, temperature, or taste?”
• “Do you fear choking, vomiting, pain, or an allergic reaction when eating?”
• “Has a prior choking, vomiting, or painful eating event changed what you can eat?”
• “Is it lack of appetite or little interest in food, rather than wanting to lose weight?”
• “Has the range of accepted foods become increasingly narrow?”

5. Assess impact and medical risk

• “What has your weight been over the last 3 to 6 months? Any unplanned loss?”
• “Are you able to drink enough? How often are you urinating?”
• “Any dizziness on standing, fainting, racing heart, severe tiredness, feeling cold, weakness, or missed periods?”
• “Do you have diabetes, thyroid disease, prior stomach surgery, neurological illness, or new medicines such as GLP-1 drugs or opioids?”
• “Any low mood, anxiety, self-harm, or suicidal thoughts?”

Practical interpretation