Summary
Definition
History and exam
Key diagnostic factors
- significantly low body weight
- fear of gaining weight or becoming fat, or behaviors 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
- amenorrhea
- decreased subcutaneous fat
Other diagnostic factors
- general fatigue, muscle weakness, and poor concentration
- significant preoccupation with thoughts of food
- orthostatic hypotension
- nonspecific gastrointestinal symptoms
- cardiac symptoms and signs
- changes to hair, skin, and nails
- dependent edema
- osteopenia or osteoporosis
Risk factors
- female sex
- adolescence and puberty
- obsessive and perfectionist traits
- exposure to Western media
- genetic influence
- middle and upper socioeconomic classes
- athlete
- appearance-related teasing
- childhood maltreatment
- celiac disease
- type 1 diabetes mellitus
Diagnostic tests
1st tests to order
- clinical diagnosis
- CBC
- serum chemistry
- thyroid function tests
- liver function tests
- blood glucose
- urinalysis
- Sit Up-Stand-Squat (SUSS) test
Tests to consider
- Sick, Control, One, Fat, and Food (SCOFF) questionnaire
- ECG
- bone densitometry (dual-energy x-ray absorptiometry)
- estradiol in females
- testosterone in males
- urine or serum pregnancy test
Treatment algorithm
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 receives royalties from UpToDate and Oxford University Press for authorship and has served as a clinical advisor to Equip Health, Inc.
B. Timothy Walsh, MD
Professor of Psychiatry
Columbia University
New York
NY
Disclosures
BTW has received royalties and honoraria for writing, editing, speaking, or consulting from Guilford Publications, McGraw-Hill, Oxford University Press, UpToDate, Wiley, the University of British Columbia, Silverhill Hospital, 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.
References
Key articles
American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed., text revision (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022.
National Institute for Health and Care Excellence. Eating disorders: recognition and treatment. Dec 2020 [internet publication].Full text
American Psychiatric Association. Practice guideline for the treatment of patients with eating disorders. Feb 2023 [internet publication].Full text
Royal College of Psychiatrists. Medical emergencies in eating disorders (MEED): guidance on recognition and management. Oct 2023 [internet publication].Full text
Hornberger LL, Lane MA, Committee on Adolescence. Identification and management of eating disorders in children and adolescents. Pediatrics. 2021 Jan;147(1):e2020040279.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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