Last reviewed: 28 Aug 2021
Last updated: 02 Sep 2021

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

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

Risk factors

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

Diagnostic investigations

1st investigations to order

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

Investigations to consider

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

Treatment algorithm

Contributors

Authors

Evelyn Attia, MD

Professor of Psychiatry

Columbia University and Weill Cornell Medical College

New York

NY

Disclosures

EA receives royalties from UpToDate for authorship.

B. Timothy Walsh, MD

Professor of Psychiatry

Columbia University

New York

NY

Disclosures

BTW has received royalties from Guilford Press, McGraw-Hill, Oxford University Press, the British Medical Journal, Johns Hopkins University Press, and UpToDate for authorship, and from Guidepoint Global for consultation.

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.

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