Psych CASC / OSCE · general-adult
Explain OSFED and atypical anorexia to a family — CASC communication station
MRCPsych/FRANZCP-style communication station: explain OSFED atypical AN, medical risk at non-low BMI, family role, without jargon overload.
On this page & tools
Target exams
Station brief
Format. Communication station, approximately 7–10 minutes active time after reading. You are the psychiatry registrar in the adolescent clinic. [4]
Candidate instructions. Explain atypical anorexia as an OSFED example in plain language; why large weight loss matters even when BMI is not low; medical checks; family-supported renourishment and psychological therapy (CBT-E ideas); correct unhelpful “looks healthy” comments; check understanding and safety-net. [1][2][4]
Candidate scenario
The young person meets atypical AN features within OSFED. Bradycardia is present. Parents are confused that the letter says she does not have “full anorexia” and fear the team is minimising. They want to know if she can keep competitive sport. You plan medical monitoring, nutritional restoration, family involvement, and specialist ED psychological care. [1][4]
Marking domains
- Empathy, structure, non-stigmatising language
- Accurate plain-language OSFED / atypical AN explanation
- Clear message: residual label ≠ mild illness
- Medical risk rationale (weight-loss amount/rate, heart rate, bloods)
- Family role in renourishment; reduce accommodation of exercise/rules
- CBT-E/therapy overview without overselling a drug cure
- Sport/exercise safety boundaries
- Teach-back and crisis/medical red-flag plan [1][3][4]
Reveal assessor key
Open and agenda-set. Name time; ask main worries (is it “real anorexia”?; sport; blame). [4]
Explain OSFED / atypical AN. “Your child has the thinking and behaviours of anorexia — fear of weight gain, strict control of food and exercise, and a large weight loss — but the current weight number is not in the very low range, so the manual uses a category called other specified feeding or eating disorder, example atypical anorexia. That name is about criteria checklists, not about seriousness.” [1][4]
Why it is still serious. Large or rapid weight loss can slow the heart and disturb body chemistry even when BMI looks normal. Looking “not underweight” can hide medical risk. [1][2]
Medical plan. Checks of heart rate, blood pressure, blood salts including phosphate when renourishing, and ECG when needed. Hospital care if unstable. [1][4]
Treatment. Food is medicine first: steady renourishment with family support. Therapy works on food rules and the over-importance of shape and weight (CBT-E style). Sport pauses until medical clearance and regular eating are safer. [3][4]
What not to say. Avoid “you look fine” or “at least you’re not underweight.” Support means structured meals, not debates about one more training session. [4]
Close. Summarise, teach-back, written plan, crisis and medical red flags, follow-up. [4]
References
- [1]Sawyer SM, Whitelaw M, Le Grange D, et al. Physical and Psychological Morbidity in Adolescents With Atypical Anorexia Nervosa Pediatrics, 2016.PMID 27025958
- [2]Whitelaw M, Lee KJ, Gilbertson H, Sawyer SM Predictors of Complications in Anorexia Nervosa and Atypical Anorexia Nervosa J Adolesc Health, 2018.PMID 30454732
- [3]Fairburn CG, Cooper Z, Doll HA, et al. Transdiagnostic cognitive-behavioral therapy for patients with eating disorders: a two-site trial with 60-week follow-up Am J Psychiatry, 2009.PMID 19074978
- [4]Hay P, Chinn D, Forbes D, et al. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of eating disorders Aust N Z J Psychiatry, 2014.PMID 25351912