When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Last reviewed: 23 Oct 2024
Last updated: 12 Dec 2023

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • significantly low body weight
  • fear of gaining weight or becoming fat, or behaviours that interfere with weight gain despite evidence of significantly low body weight
  • disturbed body image
  • calorie restriction
  • binge-eating and/or purging
  • misuse of laxatives, diuretics, or diet pills
  • amenorrhoea
  • decreased subcutaneous fat
Full details

Other diagnostic factors

  • general fatigue, weakness, and poor concentration
  • significant preoccupation with thoughts of food
  • orthostatic hypotension
  • non-specific gastrointestinal symptoms
  • cardiac symptoms and signs
  • changes to hair, skin, and nails
  • dependent oedema
  • osteopenia or osteoporosis
Full details

Risk factors

  • female sex
  • adolescence and puberty
  • obsessive and perfectionist traits
  • exposure to Western media
  • genetic influence
  • middle and upper socio-economic classes
Full details

Diagnostic investigations

1st investigations to order

  • FBC
  • serum chemistry
  • thyroid function tests
  • liver function tests
  • urinalysis
Full details

Investigations to consider

  • ECG
  • bone densitometry (dual-energy x-ray absorptiometry)
  • estradiol in females
  • testosterone in males
Full details

Treatment algorithm

ACUTE

medically stable and suitable for outpatient treatment

medically unstable or outpatient failure

Contributors

Authors

Evelyn Attia, MD

Professor of Psychiatry

Columbia University and Weill Cornell Medical College

New York

NY

Disclosures

EA is a board member of a not-for-profit religious organisation, a research advisory board member of National Eating Disorders Association (NEDA), a not-for-profit advocacy organisation and a clinical advisor to Equip Health, a for-profit entity that offers telehealth treatment for eating disorders to adolescents.She does not receive payments for the above. She receives research support from the National Institute for Mental Health (NIMH); no conflict. She is involved in no contract research at present, is expecting to begin a contract with COMPASS Pathways to support a multi-site study of psilocybin for anorexia nervosa. She regularly lectures and educates on the subject of eating disorders but does not receive payment for these activities. She receives royalties from UpToDate for written sections. She has stock options from Equip Health.

B. Timothy Walsh, MD

Professor of Psychiatry

Columbia University

New York

NY

Disclosures

BTW has received royalties and honoraria for talks, publications and reviews from Guilford Publications, McGraw-Hill, Oxford University Press, UpToDate, Wiley, the University of British Columbia, Guidepoint Global, the University of Alabama, the American Society for Clinical Psychopharmacology, Health Advances, and Dell Medical School.

Acknowledgements

Professor Evelyn Attia and Professor B. Timothy Walsh would like to gratefully acknowledge Dr Pauline S. Powers and Dr Abby M. Irwin, previous contributors to this topic.

Disclosures

PSP and AMI declare that they have no competing interests.

Peer reviewers

Heather Thompson-Brenner, MD

Director

Eating Disorders Program Center for Anxiety and Related Disorders

Psychology Department

Boston University

Boston

MA

Disclosures

HTB declares that she has no competing interests.

  • Anorexia nervosa images
  • Differentials

    • Bulimia nervosa
    • Avoidant-restrictive food intake disorder (ARFID)
    • Depression
    More Differentials
  • Guidelines

    • Practice guideline for the treatment of patients with eating disorders
    • Guidelines for the management of eating disorders
    More Guidelines
  • Patient information

    Anorexia

    Anorexia: questions to ask your doctor

    More Patient information
  • Calculators

    Body Mass Index (BMI) percentiles for boys (2 to 20 years)

    Body Mass Index (BMI) percentiles for girls (2 to 20 years)

    More Calculators
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer