Sections View Full Chapter Figures Tables Videos Full Chapter Figures Tables Videos Supplementary Content + Print Section ++ For further information, see CMDT Part 29-05: Anorexia Nervosa + Key Features Print Section ++ ++ Essentials of Diagnosis ++ Disturbance of body image and intense fear of becoming fat Weight loss, leading to body weight 15% below expected In females, absence of three consecutive menstrual cycles ++ General Considerations ++ Begins in the years between adolescence and young adulthood Cause not known, probably of primary psychiatric origin Must exclude medical or psychiatric illnesses that can account for anorexia, weight loss ++ Demographics ++ Occurs most commonly in females (90%), predominantly middle and upper income Estimated prevalence 270 cases per 100,000 population for females 22 cases per 100,000 population for males + Clinical Findings Print Section ++ ++ Symptoms and Signs ++ Loss of body fat with severe emaciation Dry and scaly skin Increased lanugo body hair Parotid enlargement and edema In severe cases, bradycardia, hypotension, and hypothermia Cold intolerance Constipation Amenorrhea ++ Differential Diagnosis ++ Endocrine and metabolic disorders Panhypopituitarism Addison disease Hyperthyroidism Diabetes mellitus Gastrointestinal disorders Malabsorption Pancreatic insufficiency Crohn disease Gluten enteropathy Chronic infections, eg, tuberculosis Cancer, eg, lymphoma Rare CNS disorders, eg, hypothalamic tumor Severe malnutrition Depression Obsessive-compulsive disorder Body dysmorphic disorder Malignancy AIDS Substance abuse + Diagnosis Print Section ++ ++ Laboratory Tests ++ Check for anemia, leukopenia, electrolyte abnormalities, and elevations of blood urea nitrogen and serum creatinine Serum cholesterol level often increased Luteinizing hormone level depressed and impaired response to luteinizing hormone-releasing hormone + Treatment Print Section ++ ++ Medications ++ Tricyclic antidepressants, selective serotonin reuptake inhibitors, and lithium carbonate are effective in some cases ++ Therapeutic Procedures ++ Treatment goal: restoration of normal body weight and improvement in psychological difficulties Supportive care Structured behavioral therapy Intensive psychotherapy Family therapy Hospitalization may be necessary Treatment by experienced teams successful in about two-thirds of cases + Outcome Print Section ++ ++ Complications ++ Poor dentition Pharyngitis Esophagitis Aspiration Gastric dilatation Pancreatitis Constipation Hemorrhoids Dehydration Electrolyte abnormalities ++ Prognosis ++ 50% of patients continue to experience difficulties with eating behavior and psychiatric problems 2–6% of patients die of the complications of the disorder or from suicide ++ When to Refer ++ Adolescents and young adults with otherwise unexplained weight loss should be evaluated by a psychiatrist All patients with diagnosed anorexia nervosa should be co-managed with a psychiatrist ++ When to Admit ++ Signs of hypovolemia, major electrolyte disorders, and severe protein-energy malnutrition Failure to improve with outpatient management + References Print Section ++ + +Dalle Grave R et al. Cognitive behavioral therapy for anorexia nervosa: an update. Curr Psychiatry Rep. 2016 Jan;18(1):2. [PubMed: 26689208] + +Franko DL et al. Predictors of long-term recovery in anorexia nervosa and bulimia nervosa: data from a 22-year longitudinal study. J Psychiatr Res. 2018 Jan;96:183–8. [PubMed: 29078155] + +Hay PJ et al. Individual psychological therapy in the outpatient treatment of adults with anorexia nervosa. Cochrane Database Syst Rev. 2015 Jul 27;(7):CD003909. [PubMed: 26212713] + +Himmerich H et al. Psychopharmacological advances in eating disorders. Expert Rev Clin Pharmacol. 2018 Jan;11(1):95–108. [PubMed: 28933969] + +Hirst RB et al. Anorexia nervosa and bulimia nervosa: a meta-analysis of executive functioning. Neurosci Biobehav Rev. 2017 Dec;83:678–90. [PubMed: 28851577] + +Khalsa SS et al. What happens after treatment? A systematic review of relapse, remission, and recovery in anorexia nervosa. J Eat Disord. 2017 Jun 14;5:20. [PubMed: 28630708] + +McElroy SL et al. Psychopharmacologic treatment of eating disorders: emerging findings. Curr Psychiatry Rep. 2015 May; 17(5):35. [PubMed: 25796197] + +Sachs KV et al. Cardiovascular complications of anorexia nervosa: a systematic review. Int J Eat Disord. 2016 Mar;49(3):238–48. [PubMed: 26710932] + +Sala M et al. Emotion-focused treatments for anorexia nervosa: a systematic review of the literature. Eat Weight Disord. 2016 Jun;21(2):147–64. [PubMed: 26886827] + +Treasure J. Applying evidence-based management to anorexia nervosa. Postgrad Med J. 2016 Sep;92(1091):525–31. [PubMed: 26944338] + +Westmoreland P et al. Medical complications of anorexia nervosa and bulimia. Am J Med. 2016 Jan;129(1):30–7. [PubMed: 26169883]