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Anorexia nervosa

  • Overview
  • Theory
  • Diagnosis
  • Management
  • Follow up
  • Resources
Last reviewed: 13 Sep 2025
Last updated: 22 May 2025

Summary

Definição

História e exame físico

Principais fatores diagnósticos

  • presença de fatores de risco
  • peso corporal significativamente baixo
  • medo de ganhar peso ou engordar ou comportamentos que interferem no ganho de peso, apesar das evidências de peso corporal significativamente baixo
  • imagem corporal distorcida
  • restrição calórica
  • compulsão alimentar periódica e/ou purgativa
  • uso indevido de laxantes, diuréticos ou comprimidos dietéticos
  • amenorreia
  • diminuição da gordura subcutânea
Full details

Other diagnostic factors

  • fadiga geral, fraqueza muscular e baixa concentração
  • significativa preocupação com pensamentos sobre comida
  • hipotensão ortostática
  • sintomas gastrointestinais inespecíficos
  • sinais e sintomas cardíacos
  • alterações nos cabelos, pele e unhas
  • edema dependente
  • osteopenia ou osteoporose
Full details

Risk factors

  • sexo feminino
  • adolescência e puberdade
  • traços obsessivos e perfeccionistas
  • exposição à mídia ocidental
  • influência genética
  • classes socioeconômicas média e alta
  • atleta
  • provocações relacionadas à aparência
  • maus-tratos na infância
  • doença celíaca
  • diabetes mellitus do tipo 1
Full details

Diagnostic investigations

1st investigations to order

  • diagnóstico clínico
  • Hemograma completo
  • bioquímica sérica
  • testes da função tireoidiana
  • testes da função hepática
  • glicose sanguínea
  • urinálise
  • Teste de sentar, levantar e agachar
Full details

Investigations to consider

  • Questionário SCOFF (Enjoado [Sick], Controle [Controle], Uma medida [One stone], Gordo [Fat], Comida [Food])
  • eletrocardiograma (ECG)
  • densitometria óssea (absorciometria por dupla emissão de raios X)
  • estradiol em indivíduos do sexo feminino
  • testosterona em indivíduos do sexo masculino
  • teste de gravidez urinário ou sérico
Full details

Treatment algorithm

ACUTE

clinicamente estável e adequado para tratamento ambulatorial

medicamente instável ou falha no tratamento ambulatorial

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.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed., text revision (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022.

National Institute for Health and Care Excellence. Eating disorders: recognition and treatment. Dec 2020 [internet publication].Full text

American Psychiatric Association. Practice guideline for the treatment of patients with eating disorders. Feb 2023 [internet publication].Full text

Royal College of Psychiatrists. Medical emergencies in eating disorders (MEED): guidance on recognition and management. Oct 2023 [internet publication].Full text

Hornberger LL, Lane MA, Committee on Adolescence. Identification and management of eating disorders in children and adolescents. Pediatrics. 2021 Jan;147(1):e2020040279.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Anorexia nervosa images

  • Differentials

    • Bulimia nervosa
    • Transtorno da evitação/restrição de ingestão alimentar
    • Depression
    More Differentials

  • Guidelines

    • Determining treatment goal weights for children and adolescents with anorexia nervosa
    • Practice guideline for the treatment of patients with eating disorders
    More Guidelines

  • Patient information

    Anorexia: perguntas a fazer ao seu médico

    Anorexia

    More Patient information

  • Calculators

    Percentis do índice de massa corporal (IMC) para meninos (2 a 20 anos)

    Percentis do índice de massa corporal (IMC) para meninas (2 a 20 anos)

    More Calculators
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