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, 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
Diagnostic tests
1st tests to order
- CBC
- serum chemistry
- thyroid function tests
- liver function tests
- urinalysis
Tests to consider
- ECG
- bone densitometry (dual-energy x-ray absorptiometry)
- estradiol in females
- testosterone in males
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 is a board member of a not-for-profit religious organization, a research advisory board member of National Eating Disorders Association (NEDA), a not-for-profit advocacy organization 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.
Differentials
- Bulimia nervosa
- Avoidant-restrictive food intake disorder (ARFID)
- Depression
More DifferentialsGuidelines
- The hospitalized adolescent
- Practice guideline for the treatment of patients with eating disorders
More GuidelinesPatient information
Anorexia
Anorexia: questions to ask your doctor
More Patient informationCalculators
Body Mass Index (BMI) percentiles for boys (2 to 20 years)
Body Mass Index (BMI) percentiles for girls (2 to 20 years)
More Calculators- Log in or subscribe to access all of BMJ Best Practice
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