Eating Disorder SOAP Note Example for Therapists

In eating disorders, the note needs concrete data that can be compared from week to week: frequency of binges and compensatory behaviours, eating pattern and control behaviours. It also needs to reflect coordination with medical follow-up, which is part of care.

The example below is fictional and educational. It is not a diagnostic assessment or a medical or risk assessment, and it does not replace professional judgement or applicable documentation requirements.

Fictional eating disorder SOAP note example

Context: Tenth session of cognitive behavioural therapy for eating disorders. Diagnosis of bulimia nervosa recorded at the initial assessment. Parallel medical follow-up with their GP.

Subjective: The person reports three binges and two episodes of self-induced vomiting this week, compared with five and four two weeks ago. They followed the pattern of three meals and two planned snacks on five of the seven days; the days without breakfast coincide with the afternoon binges. They explain that they weigh themselves several times a day “to keep control” and that, when the number goes up, they skip the next meal. They have an appointment with their doctor next week for follow-up blood tests. When asked, they deny dizziness, fainting and use of laxatives or diuretics.

Objective: Brings the completed food record. Speaks about their body with intense self-criticism (“I'm huge”) and shows visible distress when reviewing the binge days. Participates in reviewing the record and identifies without help the link between skipping breakfast and the afternoon binge.

Assessment: Reduction in binges and compensatory behaviours associated with more regular eating. The cycle of restriction, binge and vomiting remains active on days when meals are skipped. Frequent weighing maintains preoccupation with weight and feeds restriction. Overvaluation of shape and weight remains the main maintaining factor in the formulation. Purging behaviours make continued medical follow-up necessary.

Plan: Maintain regular eating (three meals and two planned snacks), prioritising breakfast. Replace weighing at home with weekly weighing in session, as agreed. Continue the food record. With their consent, coordinate with their GP after the blood tests. Review the frequency of binges and vomiting at the next session.

Why it is written this way

Behaviours are recorded with comparable frequencies. In eating disorders, that data shows progress more clearly than a general impression such as “things have gone better”.

The note records the link between behaviours (skipping breakfast, binge, vomiting) because that is what guides the intervention.

The comment about their body is quoted as the person's own expression. The clinician does not add descriptions of their physical appearance that contribute nothing to care. If weight is recorded, it is worth noting who takes it and in what context.

Medical coordination appears in the plan with its condition: consent. Purging behaviours can have physical consequences, such as electrolyte disturbances, so medical follow-up is part of treatment and not an administrative detail. The question about dizziness, fainting and other compensatory behaviours is recorded for the same reason.

The same session as a progress note

Tenth session. Three binges and two episodes of vomiting this week (five and four two weeks ago). Regular eating (three meals and two snacks) on five of seven days; binges coincide with days without breakfast. Weighing several times a day, with restriction when weight goes up. Intense bodily self-criticism in session. Denies dizziness, fainting and use of laxatives or diuretics. Agreed: weekly weighing in session, prioritising breakfast, and coordination with the GP after the blood tests, with their consent.

Questions to use during review

• Are behaviours recorded with frequencies that can be compared from week to week?
• Does the note reflect the link between restriction, binges and compensatory behaviours?
• Does the note avoid descriptions of the body or judgements that contribute nothing to care?
• Is medical follow-up clear, and whether there is consent to coordinate?
• If physical warning signs appear, does the note record what was done and who was involved in coordination?

See the SOAP notes guide and the guide to mental health progress notes. You can also compare this case with the depression example or the alcohol use example.

Clara prepares an editable draft from the session. The clinician reviews the figures, the language about the body and the planned coordination before adding it to the record. See AI clinical notes with Clara.