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Anorexia nervosa

  • Overview
  • Theory
  • Diagnosis
  • Management
  • Follow up
  • Resources
Last reviewed: 21 Sep 2025
Last updated: 22 May 2025

Summary

Definición

Anamnesis y examen

Principales factores de diagnóstico

  • 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
Todos los datos

Otros factores de diagnóstico

  • 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
Todos los datos

Factores de riesgo

  • 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
Todos los datos

Pruebas diagnósticas

Primeras pruebas diagnósticas para solicitar

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

Pruebas diagnósticas que deben considerarse

  • 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
Todos los datos

Algoritmo de tratamiento

Agudo

clinicamente estável e adequado para tratamento ambulatorial

medicamente instável ou falha no tratamento ambulatorial

Colaboradores

Autores

Evelyn Attia, MD

Professor of Psychiatry

Columbia University and Weill Cornell Medical College

New York

NY

Divulgaciones

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

Раскрытие информации

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.

Выражение благодарностей

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.

Раскрытие информации

PSP and AMI declare that they have no competing interests.

Рецензенты

Heather Thompson-Brenner, MD

Director

Eating Disorders Program Center for Anxiety and Related Disorders

Psychology Department

Boston University

Boston

MA

Раскрытие информации

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.

Список литературы

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.

Основные статьи

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].Полный текст

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

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

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

Статьи, указанные как источники

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