“I keep feeling faint, I think I’m just run down”

Dizziness, faints, fatigue, cold intolerance and amenorrhoea in a thin, high-achieving teenager presenting for "iron tablets" is an eating disorder until proven otherwise — and the dizziness is the door, not the diagnosis. The critical clinical task is recognising that eating disorders carry potentially dangerous MEDICAL instability: a video call cannot assess it, so arrange a same-day in-person assessment of lying and standing pulse/BP (bradycardia, postural drop), weight, BMI and rate of loss, ability to rise, temperature (RCPsych MEED, CR233, 2022), with collateral from family, and arrange bloods (FBC, U&E, phosphate, magnesium, calcium, glucose, LFTs) and an ECG (NICE NG69) with refeeding awareness, escalating to same-day admission if red MEED features. The examinable hidden agenda is that she came to fix the dizziness so she can keep restricting; underneath is terror of losing control and being "made to gain weight", with the disorder serving as control amid perfectionist pressure. Open the subject gently (never bluntly or with food/weight battles), validate the distress and control without colluding with "healthy eating", refer immediately to the community eating-disorder service (NICE NG69; NHS England CYP standard: urgent cases start treatment within 1 week), handle family involvement by age and risk, and safety-net. Confrontation makes her flee; warmth with honesty keeps her.