Modernising the Mental State Examination: embedding eating and nutritional assessment into the 21st-century MSE

The Mental State Examination (MSE) is a core component of psychiatric assessment and medical training, yet it was developed before feeding or eating disorders (FEDs) were widely recognised. FEDs are now common, clinically severe and frequently missed in routine assessments. We conducted a narrative review of the historical development of the MSE, current UK medical education standards and relevant literature, supplemented by a lived-experience perspective, to examine whether the MSE adequately captures eating behaviour, nutritional status and body image disturbance.

We identified no published studies examining the explicit inclusion of FED-related psychopathology within the MSE. Current frameworks lack systematic prompts for eating behaviours and nutrition, contributing to under-recognition. Contributing factors include historical MSE design, limited curriculum coverage, clinician uncertainty and patient non-disclosure.

Embedding brief, semi-structured prompts into the MSE is a feasible training-aligned approach to improve detection, support curriculum modernisation and enhance patient safety.