Approach Considerations

Because an eating disorder is a clinical diagnosis, no definitive diagnostic tests are available for anorexia nervosa. However, given the multi-organ system effects of starvation, a thorough medical evaluation is warranted. Basic tests include the following:

Physical and mental status evaluation
Complete blood count (CBC)
Metabolic panel
Urinalysis
Pregnancy test (in females of childbearing age)

Gastrointestinal signs include intestinal dilation from constipation and diminished intestinal motility.

Fecal occult blood may be indicative of esophagitis, gastritis, or repetitive colonic trauma from laxative abuse. Thyroid function tests, prolactin, and serum follicle-stimulating hormone (FSH) levels can differentiate anorexia nervosa from alternative causes of primary amenorrhea

CBC and ESR

Obtain a CBC with erythrocyte sedimentation rate (ESR). The hemoglobin levels are typically normal, although elevations are observed in states of dehydration. If anemia is observed, it is not due to menstrual blood loss, as these patients are usually amenorrheic. In such cases, further investigation is warranted.

The white blood cell (WBC) count is typically low due to increased margination, and thrombocytopenia is also observed. The leukopenia is not a sign that the patient is at an increased risk for infection.

The ESR is normal in anorexia nervosa. Therefore, elevations should prompt a search for an organic etiology, such as neuropsychiatric involvement including affective disorders, psychosis, cognitive dysfunction, and steroid-induced anorexia nervosa in adolescents with systemic lupus erythematosus (SLE), which may be triggered by steroid-induced changes in weight and body shape. Anorexia nervosa may be a presentation of neuropsychiatric SLE; thus, patients with anorexia nervosa who have joint symptoms, a positive antinuclear antibody, or lymphopenia should be investigated and followed for possible SLE, especially as treatment of the SLE may be associated with recovery from anorexia nervosa.^[98]

Blood Chemistries

Results can include the following:

Hyponatremia: Reflects excess water intake or the inappropriate secretion of antidiuretic hormone (ADH)
Hypokalemia: Results from diuretic or laxative use
Hypoglycemia: Results from the lack of glucose precursors in the diet or low glycogen stores; low blood glucose may also be due to impaired insulin clearance
Elevated blood urea nitrogen (BUN): Renal function is generally normal except in patients with dehydration, in whom the BUN level may be elevated (also perform a urinalysis)
Hypokalemic hypochloremic metabolic alkalosis: Observed with vomiting
Acidosis: Observed in cases of laxative abuse

Serum vitamin D and calcium levels may be helpful, especially if osteoporosis is suspected, and should always be obtained if a trial of bisphosphonates is attempted for confirmation of osteoporosis.^{[46, 99]}

Liver Function Studies

Liver function test results are minimally elevated, but levels encountered in patients with active hepatitis are not observed. Albumin and protein levels are usually normal, because although the amount of food intake is restricted, it usually contains high-quality proteins.

A dramatic elevation in cholesterol is observed in cases of starvation and may be secondary to the following: (1) a decrease in triiodothyronine (T3) levels, (2) low cholesterol-binding globulin levels, and (3) leakage of intrahepatic cholesterol.

Imaging Studies

A chest radiograph may reveal rib fractures or pneumomediastinum in the presence of other examination and laboratory findings to suggest repetitive vomiting. Patients may also show evidence of osteopenia.

Radiographic evidence of emphysematous changes may be present on chest computed tomography (CT) scans of patients with anorexia nervosa^[100]; however, these changes resolve with refeeding and weight normalization, unlike those seen in chronic obstructive pulmonary disease. Echocardiography can reveal a decreased ventricular mass and mitral valve prolapse.

Electrocardiography

Cardiovascular complications account for most of the morbidity and mortality associated with anorexia nervosa. Electrocardiography (ECG) can reveal evidence of sinus bradycardia, ST-segment elevation, T-wave flattening, low voltage, and rightward QRS axis, although these changes are clinically insignificant. A finding of QT-interval prolongation, however, may indicate that the patient is at risk for cardiac arrhythmias and sudden death.^{[101, 77, 1]}

Other Tests

The use of scales such as the MacArthur Competence Assessment Tool for Treatment (MacCAT-T) can be helpful in the assessment of mental capacity to refuse treatment.^[102]

Treatment & Management

Miller KK, Grinspoon SK, Ciampa J, Hier J, Herzog D, Klibanski A. Medical findings in outpatients with anorexia nervosa. Arch Intern Med. 2005 Mar 14. 165(5):561-6. [QxMD MEDLINE Link].
Hay P. Current approach to eating disorders: a clinical update. Intern Med J. 2020 Jan. 50 (1):24-29. [QxMD MEDLINE Link].
Cinkajzlova A, Lacinova Z, Klouckova J, Kavalkova P, Trachta P, Kosak M, et al. Angiopoietin-like protein 6 in patients with obesity, type 2 diabetes mellitus, and anorexia nervosa: The influence of very low-calorie diet, bariatric surgery, and partial realimentation. Endocr Res. 2016 May 2. 1-9. [QxMD MEDLINE Link].
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. 2007 Jun. 48(6):552-60. [QxMD MEDLINE Link].
Morris J, Twaddle S. Anorexia nervosa. BMJ. 2007 Apr 28. 334(7599):894-8. [QxMD MEDLINE Link].
Waller G. Recent advances in psychological therapies for eating disorders. F1000Res. 2016. 5:[QxMD MEDLINE Link].
Flament MF, Bissada H, Spettigue W. Evidence-based pharmacotherapy of eating disorders. Int J Neuropsychopharmacol. 2011 Mar 18. 1-19. [QxMD MEDLINE Link].
Hay PJ, Claudino AM. Clinical psychopharmacology of eating disorders: a research update. Int J Neuropsychopharmacol. 2011 Mar 25. 1-14. [QxMD MEDLINE Link].
Attia E, Kaplan AS, Walsh BT, Gershkovich M, Yilmaz Z, Musante D, et al. Olanzapine versus placebo for out-patients with anorexia nervosa. Psychol Med. 2011 Oct. 41 (10):2177-82. [QxMD MEDLINE Link].
Katzman DK, Peebles R, Sawyer SM, Lock J, Le Grange D. The role of the pediatrician in family-based treatment for adolescent eating disorders: opportunities and challenges. J Adolesc Health. 2013 Oct. 53(4):433-40. [QxMD MEDLINE Link].
Kaplan H, Sadock B. Fleischer GR, Ludwig S, eds. Synopsis of Psychiatry. 8th ed. Williams and Wilkins; 1998. 720-727.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. 5th ed. Washington, DC: APA Press; 2013.
Elran-Barak R, Accurso EC, Goldschmidt AB, Sztainer M, Byrne C, Le Grange D. Eating patterns in youth with restricting and binge eating/purging type anorexia nervosa. Int J Eat Disord. 2014 Apr 29. [QxMD MEDLINE Link].
Forman S. Eating Disorders: epidemiology, pathogenesis, and clinical features. Up to Date [online]. 2005:[Full Text].
Hoek HW, van Hoeken D. Review of the prevalence and incidence of eating disorders. Int J Eat Disord. 2003 Dec. 34(4):383-96. [QxMD MEDLINE Link].
Treasure J, Claudino AM, Zucker N. Eating disorders. Lancet. 2010 Feb 13. 375(9714):583-93. [QxMD MEDLINE Link].
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. 2011 Jul. 68(7):714-23. [QxMD MEDLINE Link].
Arun CP. Drive for leanness, anorexia nervosa, and overactivity: the missing link. Ann N Y Acad Sci. 2008 Dec. 1148:526-9. [QxMD MEDLINE Link].
Chui HT, Christensen BK, Zipursky RB, Richards BA, Hanratty MK, Kabani NJ, et al. Cognitive function and brain structure in females with a history of adolescent-onset anorexia nervosa. Pediatrics. 2008 Aug. 122 (2):e426-37. [QxMD MEDLINE Link]. [Full Text].
Paslakis G, Maas S, Gebhardt B, Mayr A, Rauh M, Erim Y. Prospective, randomized, double-blind, placebo-controlled phase IIa clinical trial on the effects of an estrogen-progestin combination as add-on to inpatient psychotherapy in adult female patients suffering from anorexia nervosa. BMC Psychiatry. 2018 Apr 10. 18 (1):93. [QxMD MEDLINE Link]. [Full Text].
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. 2006 Jan 13. 106(2):170-6. [QxMD MEDLINE Link].
Golden NH. Eating disorders in adolescence: what is the role of hormone replacement therapy?. Curr Opin Obstet Gynecol. 2007 Oct. 19(5):434-9. [QxMD MEDLINE Link].
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. 2009 Mar. 109(3):479-85, 485.e1-3. [QxMD MEDLINE Link].
Macías-Robles MD, Perez-Clemente AM, Maciá-Bobes C, Alvarez-Rueda MA, Pozo-Nuevo S. Prolonged QT interval in a man with anorexia nervosa. Int Arch Med. 2009 Jul 31. 2(1):23. [QxMD MEDLINE Link]. [Full Text].
LE Grange D. The Maudsley family-based treatment for adolescent anorexia nervosa. World Psychiatry. 2005 Oct. 4(3):142-6. [QxMD MEDLINE Link]. [Full Text].
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. 1998 Jul. 55(7):603-10. [QxMD MEDLINE Link].
Ammaniti M, Lucarelli L, Cimino S, D'Olimpio F, Chatoor I. Maternal psychopathology and child risk factors in infantile anorexia. Int J Eat Disord. 2010 Apr. 43(3):233-40. [QxMD MEDLINE Link].
Button E, Aldridge S. Season of birth and eating disorders: patterns across diagnoses in a specialized eating disorders service. Int J Eat Disord. 2007 Jul. 40(5):468-71. [QxMD MEDLINE Link].
Sokol MS, Carroll AK, Heebink DM, Hoffman-Rieken KM, Goudge CS, Ebers DD. Anorexia nervosa in identical triplets. CNS Spectr. 2009 Mar. 14(3):156-62. [QxMD MEDLINE Link].
Nilsson EW, Gillberg C, Råstam M. Familial factors in anorexia nervosa: a community-based study. Compr Psychiatry. 1998 Nov-Dec. 39(6):392-9. [QxMD MEDLINE Link].
Trace SE, Baker JH, Peñas-Lledó E, Bulik CM. The genetics of eating disorders. Annu Rev Clin Psychol. 2013. 9:589-620. [QxMD MEDLINE Link].
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. 2009 Sep. 43(13):1086-94. [QxMD MEDLINE Link].
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. 2007 Sep 14. 40(8):679-686. [QxMD MEDLINE Link].
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. 2009 Sep. 42(6):492-7. [QxMD MEDLINE Link]. [Full Text].
Grice DE, Halmi KA, Fichter MM, et al. Evidence for a susceptibility gene for anorexia nervosa on chromosome 1. Am J Hum Genet. 2002 Mar. 70(3):787-92. [QxMD MEDLINE Link].
Stergioti E, Deligeoroglou E, Economou E, Tsitsika A, Dimopoulos KD, Daponte A, et al. Gene receptor polymorphism as a risk factor for BMD deterioration in adolescent girls with anorexia nervosa. Gynecol Endocrinol. 2013 Jul. 29(7):716-9. [QxMD MEDLINE Link].
Kaye W. Neurobiology of anorexia and bulimia nervosa. Physiol Behav. 2008 Apr 22. 94(1):121-35. [QxMD MEDLINE Link]. [Full Text].
Bosanac P, Norman T, Burrows G, Beumont P. Serotonergic and dopaminergic systems in anorexia nervosa: a role for atypical antipsychotics?. Aust N Z J Psychiatry. 2005 Mar. 39(3):146-53. [QxMD MEDLINE Link].
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. 2005 Oct 11. 102(41):14865-70. [QxMD MEDLINE Link].
Galle J, Kirsch S, Kaufman M. Anorexia nervosa in a patient with congenital adrenal hyperplasia. J Pediatr Endocrinol Metab. 2013. 26(1-2):167-72. [QxMD MEDLINE Link].
Toulany A, Katzman DK, Kaufman M, Hiraki LT, Silverman ED. Chicken or the Egg: Anorexia Nervosa and Systemic Lupus Erythematosus in Children and Adolescents. Pediatrics. 2014 Jan 6. [QxMD MEDLINE Link].
Norris ML, Santos A, Obeid N, Hammond NG, Valois DD, Isserlin L, et al. Characteristics and clinical trajectories of patients meeting criteria for avoidant/restrictive food intake disorder that are subsequently reclassified as anorexia nervosa. Eur Eat Disord Rev. 2020 Jan. 28 (1):26-33. [QxMD MEDLINE Link].
Smink FR, van Hoeken D, Hoek HW. Epidemiology of eating disorders: incidence, prevalence and mortality rates. Curr Psychiatry Rep. 2012 Aug. 14(4):406-14. [QxMD MEDLINE Link]. [Full Text].
Mehler PS, Gray MC, Schulte M. Medical complications of anorexia nervosa. J Womens Health. 1997 Oct. 6(5):533-41. [QxMD MEDLINE Link].
Preti A, Girolamo Gd, Vilagut G, Alonso J, Graaf Rd, Bruffaerts R, et al. The epidemiology of eating disorders in six European countries: results of the ESEMeD-WMH project. J Psychiatr Res. 2009 Sep. 43(14):1125-32. [QxMD MEDLINE Link].
Steinhausen HC. Outcome of eating disorders. Child Adolesc Psychiatr Clin N Am. 2009 Jan. 18(1):225-42. [QxMD MEDLINE Link].
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. 2009 Nov. 42(7):636-47. [QxMD MEDLINE Link].
Udo T, Grilo CM. Prevalence and Correlates of DSM-5-Defined Eating Disorders in a Nationally Representative Sample of U.S. Adults. Biol Psychiatry. 2018 Apr 17. [QxMD MEDLINE Link].
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.
Fernandes NH, Crow SJ, Thuras P, Peterson CB. Characteristics of black treatment seekers for eating disorders. Int J Eat Disord. 2010 Apr. 43(3):282-5. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Feldman MB, Meyer IH. Childhood abuse and eating disorders in gay and bisexual men. Int J Eat Disord. 2007 Jul. 40(5):418-23. [QxMD MEDLINE Link].
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. 2009 May. 17(3):199-207. [QxMD MEDLINE Link].
Lavelle JM. Adolescent emergencies. Fleischer GR, Ludwig S, eds. Textbook of Pediatric Emergency Medicine. Philadelphia: Lippincott Williams & Wilkins; 1993. 166(12): 1503-1526.
Wentz E, Gillberg IC, Anckarsäter H, Gillberg C, Rastam M. Adolescent-onset anorexia nervosa: 18-year outcome. Br J Psychiatry. 2009 Feb. 194(2):168-74. [QxMD MEDLINE Link].
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. 2007 Oct. 63(4):365-71. [QxMD MEDLINE Link].
Steinhausen HC. The outcome of anorexia nervosa in the 20th century. Am J Psychiatry. 2002 Aug. 159(8):1284-93. [QxMD MEDLINE Link].
Franko DL, Keel PK, Dorer DJ, Blais MA, Delinsky SS, Eddy KT. What predicts suicide attempts in women with eating disorders?. Psychol Med. 2004 Jul. 34(5):843-53. [QxMD MEDLINE Link].
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. 2008 Apr. 107(1-3):231-6. [QxMD MEDLINE Link].
Halmi KA. Anorexia nervosa: an increasing problem in children and adolescents. Dialogues Clin Neurosci. 2009. 11(1):100-3. [QxMD MEDLINE Link].
Crow SJ, Peterson CB, Swanson SA, Raymond NC, Specker S, Eckert ED, et al. Increased mortality in bulimia nervosa and other eating disorders. Am J Psychiatry. 2009 Dec. 166(12):1342-6. [QxMD MEDLINE Link].
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. 2008 Apr. 107(1-3):107-16. [QxMD MEDLINE Link].
Woolrich RA, Cooper MJ, Turner HM. Metacognition in patients with anorexia nervosa, dieting and non-dieting women: a preliminary study. Eur Eat Disord Rev. 2008 Jan. 16(1):11-20. [QxMD MEDLINE Link].
Modan-Moses D, Yaroslavsky A, Kochavi B, Toledano A, Segev S, Balawi F, et al. Linear growth and final height characteristics in adolescent females with anorexia nervosa. PLoS One. 2012. 7(9):e45504. [QxMD MEDLINE Link]. [Full Text].
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. 2009 Jun. 39(6):1037-45. [QxMD MEDLINE Link].
Sylvester CJ, Forman SF. Clinical practice guidelines for treating restrictive eating disorder patients during medical hospitalization. Curr Opin Pediatr. 2008 Aug. 20(4):390-7. [QxMD MEDLINE Link].
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. 2011 Dec. 49(6):594-600. [QxMD MEDLINE Link].
Kaye WH, Bulik CM, Thornton L, Barbarich N, Masters K. Comorbidity of anxiety disorders with anorexia and bulimia nervosa. Am J Psychiatry. 2004 Dec. 161(12):2215-21. [QxMD MEDLINE Link].
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. 2009 Apr. 42(3):267-74. [QxMD MEDLINE Link].
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. 1988 Jan. 63(1):5-9. [QxMD MEDLINE Link].
Björkenstam E, Björkenstam C, Holm H, Gerdin B, Ekselius L. Excess cause-specific mortality in in-patient-treated individuals with personality disorder: 25-year nationwide population-based study. Br J Psychiatry. 2015 Oct. 207 (4):339-45. [QxMD MEDLINE Link].
Kask J, Ekselius L, Brandt L, Kollia N, Ekbom A, Papadopoulos FC. Mortality in Women With Anorexia Nervosa: The Role of Comorbid Psychiatric Disorders. Psychosom Med. 2016 Apr 29. [QxMD MEDLINE Link].
Treasure J, Nazar BP. Interventions for the Carers of Patients With Eating Disorders. Curr Psychiatry Rep. 2016 Feb. 18 (2):16. [QxMD MEDLINE Link].
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. 2011 Jul. 68(7):724-31. [QxMD MEDLINE Link].
Støving RK, Hangaard J, Hansen-Nord M, Hagen C. A review of endocrine changes in anorexia nervosa. J Psychiatr Res. 1999 Mar-Apr. 33(2):139-52. [QxMD MEDLINE Link].
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. 2007 Sep. 13(1):1531-45. [QxMD MEDLINE Link].
Vázquez M, Olivares JL, Fleta J, Lacambra I, González M. [Cardiac disorders in young women with anorexia nervosa]. Rev Esp Cardiol. 2003 Jul. 56(7):669-73. [QxMD MEDLINE Link].
Morse JL, Safdar B. Acute tension pneumothorax and tension pneumoperitoneum in a patient with anorexia nervosa. J Emerg Med. 2010 Apr. 38(3):e13-6. [QxMD MEDLINE Link].
Verhoef PA, Rampal A. Unique challenges for appropriate management of a 16-year-old girl with superior mesenteric artery syndrome as a result of anorexia nervosa: a case report. J Med Case Rep. 2009 Nov 16. 3:127. [QxMD MEDLINE Link]. [Full Text].
Nicholls DE, Lynn R, Viner RM. Childhood eating disorders: British national surveillance study. Br J Psychiatry. 2011 Apr. 198(4):295-301. [QxMD MEDLINE Link].
Price C, Schmidt MA, Adam EJ, Lacey H. Parotid gland enlargement in eating disorders: an insensitive sign?. Eat Weight Disord. 2008 Dec. 13(4):e79-83. [QxMD MEDLINE Link].
Sterling WM, Golden NH, Jacobson MS, Ornstein RM, Hertz SM. Metabolic assessment of menstruating and nonmenstruating normal weight adolescents. Int J Eat Disord. 2009 Nov. 42(7):658-63. [QxMD MEDLINE Link].
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. 2009 Mar. 43(3):235-43. [QxMD MEDLINE Link].
Ziora K, Ziora D, Oswiecimska J, et al. Spirometric parameters in malnourished girls with anorexia nervosa. J Physiol Pharmacol. 2008 Dec. 59 suppl 6:801-7. [QxMD MEDLINE Link].
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. 2009 Sep. 42(6):522-30. [QxMD MEDLINE Link].
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. 2009 Jun. 6(3):155-63. [QxMD MEDLINE Link].
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. 2008 Dec. 13(4):198-204. [QxMD MEDLINE Link].
Jordan J, Joyce PR, Carter FA, et al. Specific and nonspecific comorbidity in anorexia nervosa. Int J Eat Disord. 2008 Jan. 41(1):47-56. [QxMD MEDLINE Link].
Morgan JF, Reid F, Lacey JH. The SCOFF questionnaire: assessment of a new screening tool for eating disorders. BMJ. 1999 Dec 4. 319(7223):1467-8. [QxMD MEDLINE Link].
Altinyazar V, Kiylioglu N, Salkin G. Anorexia nervosa and Wernicke Korsakoff's syndrome: atypical presentation by acute psychosis. Int J Eat Disord. 2010 Dec. 43(8):766-9. [QxMD MEDLINE Link].
Kreipe RE, Birndorf SA. Eating disorders in adolescents and young adults. Med Clin North Am. 2000 Jul. 84(4):1027-49, viii-ix. [QxMD MEDLINE Link].
Nicholls D, Viner R. Eating disorders and weight problems. BMJ. 2005 Apr 23. 330(7497):950-3. [QxMD MEDLINE Link].
Jones ER, Morgan JF, Arcelus J. Managing physical risk in anorexia nervosa. Adv Psychiatrist Treat. 2013. 19:201-2.
Takeshima M, Ishikawa H, Kitadate A, Sasaki R, Kobayashi T, Nanjyo H, et al. Anorexia nervosa-associated pancytopenia mimicking idiopathic aplastic anemia: a case report. BMC Psychiatry. 2018 May 25. 18 (1):150. [QxMD MEDLINE Link].
Letranchant A, Pigneur B, Flament M, Godart N. Eating disorder or oesophageal achalasia during adolescence: diagnostic difficulties. Eat Weight Disord. 2018 May 17. [QxMD MEDLINE Link].
Puxley F, Midtsund M, Iosif A, Lask B. PANDAS anorexia nervosa--endangered, extinct or nonexistent?. Int J Eat Disord. 2008 Jan. 41(1):15-21. [QxMD MEDLINE Link].
Roberts CM, Martin-Clavijo A, Winston AP, Dharmagunawardena B, Gach JE. Malnutrition and a rash: think zinc. Clin Exp Dermatol. 2007 Nov. 32(6):654-7. [QxMD MEDLINE Link].
Toulany A, Katzman DK, Kaufman M, Hiraki LT, Silverman ED. Chicken or the egg: anorexia nervosa and systemic lupus erythematosus in children and adolescents. Pediatrics. 2014 Feb. 133(2):e447-50. [QxMD MEDLINE Link].
Ward L, Tricco AC, Phuong P, et al. Bisphosphonate therapy for children and adolescents with secondary osteoporosis. Cochrane Database Syst Rev. 2007 Oct 17. CD005324. [QxMD MEDLINE Link].
Coxson HO, Chan IH, Mayo JR, Hlynsky J, Nakano Y, Birmingham CL. Early emphysema in patients with anorexia nervosa. Am J Respir Crit Care Med. 2004 Oct 1. 170(7):748-52. [QxMD MEDLINE Link].
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. 2007 Apr 5. 1-6. [QxMD MEDLINE Link].
Elzakkers IFFM, Danner UN, Grisso T, Hoek HW, van Elburg AA. Assessment of mental capacity to consent to treatment in anorexia nervosa: A comparison of clinical judgment and MacCAT-T and consequences for clinical practice. Int J Law Psychiatry. 2018 May - Jun. 58:27-35. [QxMD MEDLINE Link]. [Full Text].
Gowers SG. Management of eating disorders in children and adolescents. Arch Dis Child. 2008 Apr. 93(4):331-4. [QxMD MEDLINE Link].
Muscari M. Effective management of adolescents with anorexia and bulimia. J Psychosoc Nurs Ment Health Serv. 2002 Feb. 40(2):22-31. [QxMD MEDLINE Link].
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. 2008 Nov. 43(5):425-31. [QxMD MEDLINE Link].
Golden NH. Variability in admission practices for teens hospitalized with anorexia nervosa: a call for evidence-based outcome studies. J Adolesc Health. 2008 Nov. 43(5):417-8. [QxMD MEDLINE Link].
Lehmann CS, Hofmann T, Elbelt U, Rose M, Correll CU, Stengel A, et al. The Role of Objectively Measured, Altered Physical Activity Patterns for Body Mass Index Change during Inpatient Treatment in Female Patients with Anorexia Nervosa. J Clin Med. 2018 Sep 18. 7 (9):[QxMD MEDLINE Link].
Divasta AD, Feldman HA, Beck TJ, Leboff MS, Gordon CM. Does hormone replacement normalize bone geometry in adolescents with anorexia nervosa?. J Bone Miner Res. 2014 Jan. 29(1):151-7. [QxMD MEDLINE Link]. [Full Text].
Herpertz-Dahlmann B, Salbach-Andrae H. Overview of treatment modalities in adolescent anorexia nervosa. Child Adolesc Psychiatr Clin N Am. 2009 Jan. 18(1):131-45. [QxMD MEDLINE Link].
Tchanturia K, Larsson E, Brown A. Benefits of group cognitive remediation therapy in anorexia nervosa: case series. Neuropsychiatr. 2016 Mar. 30 (1):42-49. [QxMD MEDLINE Link].
Mercado D, Schmidt U, O'Daly OG, Campbell IC, Werthmann J. Food related attention bias modification training for anorexia nervosa and its potential underpinning mechanisms. J Eat Disord. 2020. 8:1. [QxMD MEDLINE Link].
Higgins J, Hagman J, Pan Z, MacLean P. Increased physical activity not decreased energy intake is associated with inpatient medical treatment for anorexia nervosa in adolescent females. PLoS One. 2013. 8(4):e61559. [QxMD MEDLINE Link]. [Full Text].
Rio A, Whelan K, Goff L, Reidlinger DP, Smeeton N. Occurrence of refeeding syndrome in adults started on artificial nutrition support: prospective cohort study. BMJ Open. 2013 Jan 11. 3(1):[QxMD MEDLINE Link]. [Full Text].
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. 2007 Aug. 26(4):421-9. [QxMD MEDLINE Link].
Mehler PS, Winkelman AB, Andersen DM, Gaudiani JL. Nutritional rehabilitation: practical guidelines for refeeding the anorectic patient. J Nutr Metab. 2010. 2010:[QxMD MEDLINE Link]. [Full Text].
Krantz MJ, Mehler PS. Resting tachycardia, a warning sign in anorexia nervosa: case report. BMC Cardiovasc Disord. 2004 Jul 16. 4:10. [QxMD MEDLINE Link].
Jagielska G, Tomaszewicz-Libudzic EC, Brzozowska A. Pellagra: a rare complication of anorexia nervosa. Eur Child Adolesc Psychiatry. 2007 Oct. 16(7):417-20. [QxMD MEDLINE Link].
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. 2012 Jan. 50(1):24-9. [QxMD MEDLINE Link].
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. 2008 Jan. 41(1):37-46. [QxMD MEDLINE Link].
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. 2010 Oct. 67(10):1025-32. [QxMD MEDLINE Link].
Wallis A, Miskovic-Wheatley J, Madden S, Alford C, Rhodes P, Touyz S. Does continuing family-based treatment for adolescent anorexia nervosa improve outcomes in those not remitted after 20 sessions?. Clin Child Psychol Psychiatry. 2018 May 1. 1359104518775145. [QxMD MEDLINE Link].
Fisher CA, Hetrick SE, Rushford N. Family therapy for anorexia nervosa. Cochrane Database Syst Rev. 2010. 4:CD004780. [QxMD MEDLINE Link].
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. 2002 Jul 9. 99(14):9486-91. [QxMD MEDLINE Link].
Lock J, Fitzpatrick KK. Anorexia nervosa. Clin Evid (Online). 2009 Mar 10. 2009:[QxMD MEDLINE Link].
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. 2009 Jan. 10(1):45-8. [QxMD MEDLINE Link].
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. 2009 Apr 23. 10:23. [QxMD MEDLINE Link].
Bowers WA, Ansher LS. The effectiveness of cognitive behavioral therapy on changing eating disorder symptoms and psychopathology of 32 anorexia nervosa patients at hospital discharge and one year follow-up. Ann Clin Psychiatry. 2008 Apr-Jun. 20(2):79-86. [QxMD MEDLINE Link].
McIntosh VV, Jordan J, Carter FA, et al. Three psychotherapies for anorexia nervosa: a randomized, controlled trial. Am J Psychiatry. 2005 Apr. 162(4):741-7. [QxMD MEDLINE Link].
Geist R, Heinmaa M, Stephens D, et al. Comparison of family therapy and family group psychoeducation in adolescents with anorexia nervosa. Can J Psychiatry. 2000 Mar. 45(2):173-8. [QxMD MEDLINE Link].
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. 2009 Jun 15. 33(4):658-662. [QxMD MEDLINE Link].
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. 2000 Jul. 28(1):101-6. [QxMD MEDLINE Link].
Hay P, Chinn D, Forbes D, Madden S, Newton R, Sugenor L, et al. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of eating disorders. Aust N Z J Psychiatry. 2014 Nov. 48(11):977-1008. [QxMD MEDLINE Link].
Couturier J, Isserlin L, Norris M, et al. Canadian practice guidelines for the treatment of children and adolescents with eating disorders. J Eat Disord. 2020. 8:4. [QxMD MEDLINE Link].
Reinblatt SP, Redgrave GW, Guarda AS. Medication management of pediatric eating disorders. Int Rev Psychiatry. 2008 Apr. 20(2):183-8. [QxMD MEDLINE Link].
Kishi T, Kafantaris V, Sunday S, Sheridan EM, Correll CU. Are antipsychotics effective for the treatment of anorexia nervosa? Results from a systematic review and meta-analysis. J Clin Psychiatry. 2012 Jun. 73(6):e757-66. [QxMD MEDLINE Link].
Wildes JE, Marcus MD, Gaskill JA, Ringham R. Depressive and manic-hypomanic spectrum psychopathology in patients with anorexia nervosa. Compr Psychiatry. 2007 Sep-Oct. 48(5):413-8. [QxMD MEDLINE Link].
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. 2007 Sep. 8(13):2029-44. [QxMD MEDLINE Link].
Cooper WO, Callahan ST, Shintani A, et al. Antidepressants and suicide attempts in children. Pediatrics. 2014 Feb. 133(2):204-10. [QxMD MEDLINE Link]. [Full Text].
McKnight RF, Park RJ. Atypical antipsychotics and anorexia nervosa: a review. Eur Eat Disord Rev. 2010 Jan. 18(1):10-21. [QxMD MEDLINE Link].
Szmukler GI, Young GP, Miller G, Lichtenstein M, Binns DS. A controlled trial of cisapride in anorexia nervosa. Int J Eat Disord. 1995 May. 17(4):347-57. [QxMD MEDLINE Link].
Tchanturia K, Doris E, Mountford V, Fleming C. Cognitive Remediation and Emotion Skills Training (CREST) for anorexia nervosa in individual format: self-reported outcomes. BMC Psychiatry. 2015 Mar 20. 15:53. [QxMD MEDLINE Link].

Media Gallery

of 0

Author

Bettina E Bernstein, DO Distinguished Fellow, American Academy of Child and Adolescent Psychiatry; Distinguished Fellow, American Psychiatric Association; Clinical Assistant Professor of Neurosciences and Psychiatry, Department of Psychiatry/Psychiatric Medicine, Philadelphia College of Osteopathic Medicine; Clinical Affiliate Medical Staff, Department of Child and Adolescent Psychiatry, Children's Hospital of Philadelphia; Consultant to Gemma Services, Private Practice; Consultant PMHCC/CBH at Family Court, Philadelphia

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

Disclosure: Nothing to disclose.

Chief Editor

Caroly Pataki, MD Health Sciences Clinical Professor of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, David Geffen School of Medicine

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

Disclosure: Nothing to disclose.

Acknowledgements

Edward Bessman, MD, MBA Chairman and Clinical Director, Department of Emergency Medicine, John Hopkins Bayview Medical Center; Assistant Professor, Department of Emergency Medicine, Johns Hopkins University School of Medicine

Edward Bessman, MD, MBA is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine