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Clinical Summary

Eating disorders are characterized by the persistent disturbance of eating impairing health or psychosocial functioning and include food restriction disorders as well as binging and purging disorders. Clinical features of restriction disorders such as anorexia nervosa include emaciation, bradycardia (Fig, 27.30), lanugo (Fig. 27.28), hair loss, and xerosis. Binging and purging disorders may present with clinical manifestations associated with frequent self-induced vomiting such as acid tooth erosion (Fig, 27.29) or Russell sign, characterized by callouses on the knuckles or back of the hand secondary to repetitive self-induced vomiting over long periods of time (Fig. 27.27).

FIGURE 27.27

Eating Disorder—Russell Sign. Calluses over the dorsal metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints of the hand is Russell sign due to repeated self-induced vomiting over long periods of time. Callus formation occurs from the skin over the joints repeatedly rubbing against the maxillary incisors during self-induced vomiting. (Image appears with permission from VisualDx [].)

FIGURE 27.28

Eating Disorder—Lanugo Hair. Fine, soft, unpigmented hair seen in an adolescent or adult is a clue to anorexia nervosa. Lanugo hair is normally found on a newborn baby. (Image appears with permission from Vivian Wong, MD and VisualDx [].)

FIGURE 27.29

Eating Disorder—Acid Tooth Erosion (Bulimia). Erosive dentin exposure of the maxillary teeth due to acid from chronic vomiting. The acid erosion of lingual tooth surfaces is characteristic of bulimia. (Photo contributor: David P. Kretzschmar, DDS, MS.)

FIGURE 27.30

Eating Disorder—ECG: Sinus Bradycardia. Bradycardia in anorexia nervosa is thought to be due to increased vagal tone due to decreased metabolism due to low caloric intake. (Photo contributor: Lawrence B. Stack, MD.)

Management and Disposition

Treatment of electrolyte abnormalities such as hypokalemia and hypoglycemia should be addressed on presentation. Electrocardiogram (ECG) should be obtained to evaluate for cardiac dysrhythmias. Upon ensuring medical stability, psychiatric referral should be obtained.


  1. Electrolyte abnormalities and cardiac dysrhythmias should be screened for in patients presenting with an eating disorder.

  2. Psychiatric evaluation is the mainstay of long-term therapy after medical stabilization has been achieved.

  3. Unexplained sinus bradycardia should prompt suspicion of an eating disorder.

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