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Anorexia nervosa

Last reviewed: 10 Nov 2024
Last updated: 05 Dec 2024

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
Full details

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
Full details

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
Full details

Diagnostic tests

1st tests to order

  • clinical diagnosis
  • CBC
  • serum chemistry
  • thyroid function tests
  • liver function tests
  • blood glucose
  • urinalysis
Full details

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
Full details

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 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.

  • Anorexia nervosa images
  • Differentials

    • Bulimia nervosa
    • Avoidant-restrictive food intake disorder (ARFID)
    • Depression
    More Differentials
  • Guidelines

    • Determining treatment goal weights for children and adolescents with anorexia nervosa
    • World Federation of Societies of Biological Psychiatry (WFSBP) guidelines update 2023 on the pharmacological treatment of eating disorders
    More Guidelines
  • Patient information

    Anorexia

    Anorexia: questions to ask your doctor

    More Patient information
  • 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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