Pediatric Anorexia Nervosa Differential Diagnoses

  • Author: Bettina E Bernstein, DO; Chief Editor: Caroly Pataki, MD   more...
 
Updated: Jan 18, 2012
 
 

Diagnostic Considerations

When evaluating a patient for anorexia nervosa, the following conditions should also be considered:

  • Cancer
  • Cardiac valvular disease
  • Cataracts
  • Chronic undiagnosed organic disease (infectious, congenital, or metabolic)
  • Clostridium difficile colitis, clostridial cholecystitis
  • Cytomegalovirus esophagitis, cytomegalovirus colitis
  • Esophageal motility disorders, esophageal spasm, esophageal stricture
  • Inflammatory bowel disease, including Crohn disease and ulcerative colitis
  • Low vitamin D and calcium levels (hypocalcinosis)
  • Myeloma
  • Occult infection (if heart rate is normal or elevated)
  • Osteopenia
  • Osteoporosis
  • Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS) (rare)[55]
  • Pellagra
  • Rash (due to low zinc)[56]
  • Sheehan syndrome

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

Bettina E Bernstein, DO  Clinical Assistant Professor, Department of Psychiatry, Philadelphia College of Osteopathic Medicine; Private Practice at the Wynnewood House; Outpatient Consultant, Clinical Affiliate, Department of Child and Adolescent Psychiatry, Children's Hospital of Philadelphia; Court Appointed Evaluator, Family Court of Philadelphia; Psychiatric Consultant, Intercommunity Action, Inc, Easttown Tredyffrin School District

Bettina E Bernstein, DO is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry and American Psychiatric Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Angelo P Giardino, MD, PhD, MPH  Associate Professor, Baylor College of Medicine; Chief Medical Officer, Texas Children's Health Plan; Chief Quality Officer, Medicine, Texas Children's Hospital

Angelo P Giardino, MD, PhD, MPH is a member of the following medical societies: Academic Pediatric Association, American Academy of Pediatrics, American Professional Society on the Abuse of Children, Harris County Medical Society, Helfer Society, and International Society for Prevention of Child Abuse and Neglect

Disclosure: Bayer Honoraria Review panel membership; Pfizer Grant/research funds Independent contractor; MedImmune Honoraria Review panel membership; Teva Pharmacutical travel & honoraria Managed Care Advisory Panel; CIGNA Honoraria Physician Advisory Council

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Caroly Pataki, MD  Professor of Clinical Psychiatry and Behavioral Sciences, Department of Psychiatry, Division Chair, Child and Adolescent Psychiatry, Keck School of Medicine of the University of Southern California

Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author Jennifer DA Liburd, MD, to the development and writing of the source article.

References

  1. Slupik RI. Managing adolescents with eating disorders. Int J Fertil Womens Med. May-Jun 1999;44(3):125-30. [Medline].

  2. Fetissov SO, Harro J, Jaanisk M, et al. Autoantibodies against neuropeptides are associated with psychological traits in eating disorders. Proc Natl Acad Sci U S A. Oct 11 2005;102(41):14865-70. [Medline].

  3. APA. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: APA; 1994.

  4. Arun CP. Drive for leanness, anorexia nervosa, and overactivity: the missing link. Ann N Y Acad Sci. Dec 2008;1148:526-9. [Medline].

  5. Steiger H, Richardson J, Schmitz N, et al. Association of trait-defined, eating-disorder sub-phenotypes with (biallelic and triallelic) 5HTTLPR variations. J Psychiatr Res. Sep 2009;43(13):1086-94. [Medline].

  6. Wade TD, Gillespie N, Martin NG. A comparison of early family life events amongst monozygotic twin women with lifetime anorexia nervosa, bulimia nervosa, or major depression. Int J Eat Disord. Sep 14 2007;40(8):679-686. [Medline].

  7. Wade TD, Treloar SA, Heath AC, Martin NG. An examination of the overlap between genetic and environmental risk factors for intentional weight loss and overeating. Int J Eat Disord. Sep 2009;42(6):492-7. [Medline].

  8. Lilenfeld LR, Kaye WH, Greeno CG, et al. A controlled family study of anorexia nervosa and bulimia nervosa: psychiatric disorders in first-degree relatives and effects of proband comorbidity. Arch Gen Psychiatry. Jul 1998;55(7):603-10. [Medline].

  9. Button E, Aldridge S. Season of birth and eating disorders: patterns across diagnoses in a specialized eating disorders service. Int J Eat Disord. Jul 2007;40(5):468-71. [Medline].

  10. Preti A, Girolamo G, Vilagut G, et al. The epidemiology of eating disorders in six European countries: results of the ESEMeD-WMH project. J Psychiatr Res. Sep 2009;43(14):1125-32. [Medline].

  11. Sokol MS, Carroll AK, Heebink DM, Hoffman-Rieken KM, Goudge CS, Ebers DD. Anorexia nervosa in identical triplets. CNS Spectr. Mar 2009;14(3):156-62. [Medline].

  12. Grice DE, Halmi KA, Fichter MM, et al. Evidence for a susceptibility gene for anorexia nervosa on chromosome 1. Am J Hum Genet. Mar 2002;70(3):787-92. [Medline].

  13. Kreipe RE, Birndorf SA. Eating disorders in adolescents and young adults. Med Clin North Am. Jul 2000;84(4):1027-49, viii-ix. [Medline].

  14. Ammaniti M, Lucarelli L, Cimino S, D'Olimpio F, Chatoor I. Maternal psychopathology and child risk factors in infantile anorexia. Int J Eat Disord. Apr 2010;43(3):233-40. [Medline].

  15. Mehler PS, Gray MC, Schulte M. Medical complications of anorexia nervosa. J Womens Health. Oct 1997;6(5):533-41. [Medline].

  16. Nicholls D. Childhood eating disorders: British national surveillance study. British Journal of Psychiatry. April 2011;198(4):295-301.

  17. Feldman MB, Meyer IH. Childhood abuse and eating disorders in gay and bisexual men. Int J Eat Disord. Jul 2007;40(5):418-23. [Medline].

  18. Isomaa R, Isomaa AL, Marttunen M, Kaltiala-Heino R, Björkqvist K. The prevalence, incidence and development of eating disorders in Finnish adolescents-a two-step 3-year follow-up study. Eur Eat Disord Rev. May 2009;17(3):199-207. [Medline].

  19. Steinhausen HC. Outcome of eating disorders. Child Adolesc Psychiatr Clin N Am. Jan 2009;18(1):225-42. [Medline].

  20. Wallier J, Vibert S, Berthoz S, Huas C, Hubert T, Godart N. Dropout from inpatient treatment for anorexia nervosa: critical review of the literature. Int J Eat Disord. Nov 2009;42(7):636-47. [Medline].

  21. National Institute of Mental Health. Collaborative Psychiatric Epidemiology Surveys (CPES). Collaborative Psychiatric Epidemiology Surveys. Available at http://www.icpsr.umich.edu/CPES/. Accessed October 30, 2007.

  22. Fernandes NH, Crow SJ, Thuras P, Peterson CB. Characteristics of black treatment seekers for eating disorders. Int J Eat Disord. Apr 2010;43(3):282-5. [Medline].

  23. Raevuori A, Hoek HW, Susser E, Kaprio J, Rissanen A, Keski-Rahkonen A. Epidemiology of anorexia nervosa in men: a nationwide study of Finnish twins. PLoS ONE. 2009;4(2):e4402. [Medline].

  24. Speranza M, Loas G, Wallier J, Corcos M. Predictive value of alexithymia in patients with eating disorders: A 3-year prospective study. J Psychosom Res. Oct 2007;63(4):365-71. [Medline].

  25. Franko DL, Keel PK, Dorer DJ, Blais MA, Delinsky SS, Eddy KT. What predicts suicide attempts in women with eating disorders?. Psychol Med. Jul 2004;34(5):843-53. [Medline].

  26. Holm-Denoma JM, Witte TK, Gordon KH, et al. Deaths by suicide among individuals with anorexia as arbiters between competing explanations of the anorexia-suicide link. J Affect Disord. Apr 2008;107(1-3):231-6. [Medline].

  27. Halmi KA. Anorexia nervosa: an increasing problem in children and adolescents. Dialogues Clin Neurosci. 2009;11(1):100-3. [Medline].

  28. Witte TK, Merrill KA, Stellrecht NE, Bernert RA, Hollar DL, Schatschneider C, et al. "Impulsive" youth suicide attempters are not necessarily all that impulsive. J Affect Disord. Apr 2008;107(1-3):107-16. [Medline].

  29. Woolrich RA, Cooper MJ, Turner HM. Metacognition in patients with anorexia nervosa, dieting and non-dieting women: a preliminary study. Eur Eat Disord Rev. Jan 2008;16(1):11-20. [Medline].

  30. Kaplan AS, Walsh BT, Olmsted M, Attia E, Carter JC, Devlin MJ, et al. The slippery slope: prediction of successful weight maintenance in anorexia nervosa. Psychol Med. Jun 2009;39(6):1037-45. [Medline].

  31. Wentz E, Gillberg IC, Anckarsäter H, Gillberg C, Rastam M. Adolescent-onset anorexia nervosa: 18-year outcome. Br J Psychiatry. Feb 2009;194(2):168-74. [Medline].

  32. Forman SF, Grodin LF, Graham DA, Sylvester CJ, Rosen DS, Kapphahn CJ, et al. An eleven site national quality improvement evaluation of adolescent medicine-based eating disorder programs: predictors of weight outcomes at one year and risk adjustment analyses. J Adolesc Health. Dec 2011;49(6):594-600. [Medline].

  33. Bryant-Waugh R, Knibbs J, Fosson A, Kaminski Z, Lask B. Long term follow up of patients with early onset anorexia nervosa. Arch Dis Child. Jan 1988;63(1):5-9. [Medline].

  34. le Grange D, Eisler I. Family interventions in adolescent anorexia nervosa. Child Adolesc Psychiatr Clin N Am. Jan 2009;18(1):159-73. [Medline].

  35. Eisler I, Simic M, Russell GF, Dare C. A randomised controlled treatment trial of two forms of family therapy in adolescent anorexia nervosa: a five-year follow-up. J Child Psychol Psychiatry. Jun 2007;48(6):552-60. [Medline].

  36. Jordan J, Joyce PR, Carter FA, McIntosh VV, Luty SE, McKenzie JM, et al. The Yale-Brown-Cornell eating disorder scale in women with anorexia nervosa: what is it measuring?. Int J Eat Disord. Apr 2009;42(3):267-74. [Medline].

  37. Arcelus J, Mitchell AJ, Wales J, Nielsen S. Mortality Rates in Patients With Anorexia Nervosa and Other Eating Disorders: A Meta-analysis of 36 Studies. Arch Gen Psychiatry. Jul 2011;68(7):724-31. [Medline].

  38. Swanson SA, Crow SJ, Le Grange D, Swendsen J, Merikangas KR. Prevalence and correlates of eating disorders in adolescents: results from the national comorbidity survey replication adolescent supplement. Arch Gen Psychiatry. Jul 2011;68(7):714-23. [Medline].

  39. Matzkin V, Slobodianik N, Pallaro A, Bello M, Geissler C. Risk factors for cardiovascular disease in patients with anorexia nervosa. Int J Psychiatr Nurs Res. Sep 2007;13(1):1531-45. [Medline].

  40. Facchini M, Sala L, Malfatto G, Bragato R, Redaelli G, Invitti C. Low-K+ dependent QT prolongation and risk for ventricular arrhythmia in anorexia nervosa. Int J Cardiol. Jan 13 2006;106(2):170-6. [Medline].

  41. Golden NH. Eating disorders in adolescence: what is the role of hormone replacement therapy?. Curr Opin Obstet Gynecol. Oct 2007;19(5):434-9. [Medline].

  42. Taylor C, Lamparello B, Kruczek K, Anderson EJ, Hubbard J, Misra M. Validation of a food frequency questionnaire for determining calcium and vitamin D intake by adolescent girls with anorexia nervosa. J Am Diet Assoc. Mar 2009;109(3):479-85, 485.e1-3. [Medline].

  43. Becker AE, Grinspoon SK, Klibanski A, Herzog DB. Eating disorders. N Engl J Med. Apr 8 1999;340(14):1092-8. [Medline].

  44. Birgegård A, Björck C, Norring C, Sohlberg S, Clinton D. Anorexic self-control and bulimic self-hate: differential outcome prediction from initial self-image. Int J Eat Disord. Sep 2009;42(6):522-30. [Medline].

  45. Hrabosky JI, Cash TF, Veale D, et al. Multidimensional body image comparisons among patients with eating disorders, body dysmorphic disorder, and clinical controls: a multisite study. Body Image. Jun 2009;6(3):155-63. [Medline].

  46. Kawai K, Yamanaka T, Yamashita S, et al. Somatic and psychological factors related to the body mass index of patients with anorexia nervosa. Eat Weight Disord. Dec 2008;13(4):198-204. [Medline].

  47. Jordan J, Joyce PR, Carter FA, et al. Specific and nonspecific comorbidity in anorexia nervosa. Int J Eat Disord. Jan 2008;41(1):47-56. [Medline].

  48. Price C, Schmidt MA, Adam EJ, Lacey H. Parotid gland enlargement in eating disorders: an insensitive sign?. Eat Weight Disord. Dec 2008;13(4):e79-83. [Medline].

  49. Sterling WM, Golden NH, Jacobson MS, Ornstein RM, Hertz SM. Metabolic assessment of menstruating and nonmenstruating normal weight adolescents. Int J Eat Disord. Nov 2009;42(7):658-63. [Medline].

  50. Wade TD, Frayne A, Edwards SA, Robertson T, Gilchrist P. Motivational change in an inpatient anorexia nervosa population and implications for treatment. Aust N Z J Psychiatry. Mar 2009;43(3):235-43. [Medline].

  51. Ziora K, Ziora D, Oswiecimska J, et al. Spirometric parameters in malnourished girls with anorexia nervosa. J Physiol Pharmacol. Dec 2008;59 suppl 6:801-7. [Medline].

  52. Lesinskiene S, Barkus A, Ranceva N, Dembinskas A. A meta-analysis of heart rate and QT interval alteration in anorexia nervosa. World J Biol Psychiatry. Apr 5 2007;1-6. [Medline].

  53. Morgan JF, Reid F, Lacey JH. The SCOFF questionnaire: assessment of a new screening tool for eating disorders. BMJ. Dec 4 1999;319(7223):1467-8. [Medline].

  54. Nicholls D, Viner R. Eating disorders and weight problems. BMJ. Apr 23 2005;330(7497):950-3. [Medline].

  55. Puxley F, Midtsund M, Iosif A, Lask B. PANDAS anorexia nervosa--endangered, extinct or nonexistent?. Int J Eat Disord. Jan 2008;41(1):15-21. [Medline].

  56. Roberts CM, Martin-Clavijo A, Winston AP, Dharmagunawardena B, Gach JE. Malnutrition and a rash: think zinc. Clin Exp Dermatol. Nov 2007;32(6):654-7. [Medline].

  57. Ward L, Tricco AC, Phuong P, et al. Bisphosphonate therapy for children and adolescents with secondary osteoporosis. Cochrane Database Syst Rev. Oct 17 2007;CD005324. [Medline].

  58. Muscari M. Effective management of adolescents with anorexia and bulimia. J Psychosoc Nurs Ment Health Serv. Feb 2002;40(2):22-31. [Medline].

  59. Gowers SG. Management of eating disorders in children and adolescents. Arch Dis Child. Apr 2008;93(4):331-4. [Medline].

  60. Schwartz BI, Mansbach JM, Marion JG, Katzman DK, Forman SF. Variations in admission practices for adolescents with anorexia nervosa: a North American sample. J Adolesc Health. Nov 2008;43(5):425-31. [Medline].

  61. Golden NH. Variability in admission practices for teens hospitalized with anorexia nervosa: a call for evidence-based outcome studies. J Adolesc Health. Nov 2008;43(5):417-8. [Medline].

  62. Lawson EA, Misra M, Meenaghan E, et al. Adrenal glucocorticoid and androgen precursor dissociation in anorexia nervosa. J Clin Endocrinol Metab. Apr 2009;94(4):1367-71. [Medline].

  63. Ehrlich S, Burghardt R, Schneider N, Broecker-Preuss M, Weiss D, Merle JV, et al. The role of leptin and cortisol in hyperactivity in patients with acute and weight-recovered anorexia nervosa. Prog Neuropsychopharmacol Biol Psychiatry. Jun 15 2009;33(4):658-662. [Medline].

  64. Rigaud D, Brondel L, Poupard AT, Talonneau I, Brun JM. A randomized trial on the efficacy of a 2-month tube feeding regimen in anorexia nervosa: A 1-year follow-up study. Clin Nutr. Aug 2007;26(4):421-9. [Medline].

  65. Krantz MJ, Mehler PS. Resting tachycardia, a warning sign in anorexia nervosa: case report. BMC Cardiovasc Disord. Jul 16 2004;4:10. [Medline].

  66. Jagielska G, Tomaszewicz-Libudzic EC, Brzozowska A. Pellagra: a rare complication of anorexia nervosa. Eur Child Adolesc Psychiatry. Oct 2007;16(7):417-20. [Medline].

  67. Garber AK, Michihata N, Hetnal K, Shafer MA, Moscicki AB. A prospective examination of weight gain in hospitalized adolescents with anorexia nervosa on a recommended refeeding protocol. J Adolesc Health. Jan 2012;50(1):24-9. [Medline].

  68. Herpertz-Dahlmann B, Salbach-Andrae H. Overview of treatment modalities in adolescent anorexia nervosa. Child Adolesc Psychiatr Clin N Am. Jan 2009;18(1):131-45. [Medline].

  69. Kyriacou O, Treasure J, Schmidt U. Expressed emotion in eating disorders assessed via self-report: an examination of factors associated with expressed emotion in carers of people with anorexia nervosa in comparison to control families. Int J Eat Disord. Jan 2008;41(1):37-46. [Medline].

  70. Lock J, Le Grange D, Agras WS, Moye A, Bryson SW, Jo B. Randomized clinical trial comparing family-based treatment with adolescent-focused individual therapy for adolescents with anorexia nervosa. Arch Gen Psychiatry. Oct 2010;67(10):1025-32. [Medline].

  71. Fisher CA, Hetrick SE, Rushford N. Family therapy for anorexia nervosa. Cochrane Database Syst Rev. 2010;4:CD004780. [Medline].

  72. Morris J, Twaddle S. Anorexia nervosa. BMJ. Apr 28 2007;334(7599):894-8. [Medline].

  73. Rosenblum J, Forman S. Evidence-based treatment of eating disorders. Curr Opin Pediatr. Aug 2002;14(4):379-83. [Medline].

  74. Bergh C, Brodin U, Lindberg G, Sodersten P. Randomized controlled trial of a treatment for anorexia and bulimia nervosa. Proc Natl Acad Sci U S A. Jul 9 2002;99(14):9486-91. [Medline].

  75. Lock J, Fitzpatrick KK. Anorexia nervosa. Clin Evid (Online). Mar 10 2009;2009:[Medline].

  76. Harper K, Richter NL, Gorey KM. Group work with female survivors of childhood sexual abuse: evidence of poorer outcomes among those with eating disorders. Eat Behav. Jan 2009;10(1):45-8. [Medline].

  77. Wild B, Friederich HC, Gross G, Teufel M, Herzog W, Giel KE, et al. The ANTOP study: focal psychodynamic psychotherapy, cognitive-behavioural therapy, and treatment-as-usual in outpatients with anorexia nervosa--a randomized controlled trial. Trials. Apr 23 2009;10:23. [Medline].

  78. McIntosh VV, Jordan J, Carter FA, et al. Three psychotherapies for anorexia nervosa: a randomized, controlled trial. Am J Psychiatry. Apr 2005;162(4):741-7. [Medline].

  79. Geist R, Heinmaa M, Stephens D, et al. Comparison of family therapy and family group psychoeducation in adolescents with anorexia nervosa. Can J Psychiatry. Mar 2000;45(2):173-8. [Medline].

  80. Robin AL, Siegel PT, Moye A. Family versus individual therapy for anorexia: impact on family conflict. Int J Eat Disord. May 1995;17(4):313-22. [Medline].

  81. Thien V, Thomas A, Markin D, Birmingham CL. Pilot study of a graded exercise program for the treatment of anorexia nervosa. Int J Eat Disord. Jul 2000;28(1):101-6. [Medline].

  82. Flament MF, Bissada H, Spettigue W. Evidence-based pharmacotherapy of eating disorders. Int J Neuropsychopharmacol. Mar 18 2011;1-19. [Medline].

  83. Hay PJ, Claudino AM. Clinical psychopharmacology of eating disorders: a research update. Int J Neuropsychopharmacol. Mar 25 2011;1-14. [Medline].

  84. Wildes JE, Marcus MD, Gaskill JA, Ringham R. Depressive and manic-hypomanic spectrum psychopathology in patients with anorexia nervosa. Compr Psychiatry. Sep-Oct 2007;48(5):413-8. [Medline].

  85. Gordon CM, Grace E, Emans SJ, et al. Changes in bone turnover markers and menstrual function after short-term oral DHEA in young women with anorexia nervosa. J Bone Miner Res. Jan 1999;14(1):136-45. [Medline].

  86. Ramoz N, Versini A, Gorwood P. Eating disorders: an overview of treatment responses and the potential impact of vulnerability genes and endophenotypes. Expert Opin Pharmacother. Sep 2007;8(13):2029-44. [Medline].

  87. Simon GE, Savarino J, Operskalski B, Wang PS. Suicide risk during antidepressant treatment. Am J Psychiatry. Jan 2006;163(1):41-7. [Medline]. [Full Text].

  88. Szmukler GI, Young GP, Miller G, Lichtenstein M, Binns DS. A controlled trial of cisapride in anorexia nervosa. Int J Eat Disord. May 1995;17(4):347-57. [Medline].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.