Last reviewed: June 2018
Last updated: November  2017



History and exam

Key diagnostic factors

  • weight loss
  • fear of gaining weight
  • disturbed body image
  • calorie restriction
  • bingeing and/or purging
  • misuse of laxatives, enemas, and/or diuretics
  • amenorrhea
  • decreased subcutaneous fat

Other diagnostic factors

  • fatigue and weakness
  • poor concentration
  • fainting
  • constipation
  • lanugo body hair
  • orthostatic hypotension
  • bradycardia
  • dehydration
  • cardiac arrhythmias
  • hair loss
  • shorter stature
  • hypothermia
  • eroded dental enamel
  • scars on dorsum of hand
  • dependent edema
  • increased fractures

Risk factors

  • female gender
  • adolescence and puberty
  • obsessive and perfectionist traits
  • exposure to western media
  • middle and upper socioeconomic classes
  • identical twin affected
  • family dysfunction

Diagnostic investigations

1st investigations to order

  • CBC
  • serum chemistry
  • TFTs
  • LFTs
  • urinalysis
  • urine pregnancy test
Full details

Investigations to consider

  • ECG
  • bone densitometry
  • estradiol in females
  • testosterone in males
Full details

Treatment algorithm



Authors VIEW ALL

Professor Emeritus

University of South Florida




PSP declares that she has no competing interests.

Dr Pauline S. Powers would like to gratefully acknowledge Dr Abby M. Irwin, a previous contributor to this monograph. AMI declares that she has no competing interests.

Peer reviewers VIEW ALL


Eating Disorders Program Center for Anxiety and Related Disorders

Psychology Department

Boston University




HTB declares that she has no competing interests.

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