Anorexia nervosa

Last reviewed: 5 Sep 2022
Last updated: 01 Sep 2022

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
More key diagnostic factors

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
Other diagnostic factors

Risk factors

  • female sex
  • adolescence and puberty
  • obsessive and perfectionist traits
  • exposure to Western media
  • genetic influence
  • middle and upper socioeconomic classes
More risk factors

Diagnostic investigations

1st investigations to order

  • CBC
  • serum chemistry
  • thyroid function tests
  • liver function tests
  • urinalysis
More 1st investigations to order

Investigations to consider

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

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 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.

  • 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 (draft)
    • Guidelines for the management of eating disorders
    More Guidelines
  • Patient leaflets

    Anorexia

    Anorexia: questions to ask your doctor

    More Patient leaflets
  • 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
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