Anorexia Nervosa Diagnosis and Treatment

Introduction to Anorexia Nervosa

Anorexia nervosa presents with three core diagnostic features: persistent restriction of energy intake leading to significantly low body weight, intense fear of gaining weight or persistent behavior that interferes with weight gain, and disturbance in how one's body weight or shape is experienced, according to the American Gastroenterological Association 1

Patients with anorexia nervosa often have a distorted body image where they perceive themselves as overweight despite being significantly underweight, with self-worth becoming overly based on body shape and weight, as noted by the American Psychological Association 1, 2
Intense fear of weight gain or becoming fat is a common symptom, even when at dangerously low body weight, according to the American Medical Association 1, 3
Persistent lack of recognition of the seriousness of their current low body weight is a key feature of anorexia nervosa, as reported by the National Institute of Mental Health 1

Significantly low body weight in context of what is minimally expected for age, sex, developmental trajectory, and physical health is a physical manifestation of anorexia nervosa, as defined by the World Health Organization 1, 3
Delayed gastric emptying of solids and delayed small and large bowel transit are common physical symptoms, according to the American Gastroenterological Association 1, 4
Hypothermia, bradycardia, and hypotension, particularly in those who have lost large amounts of weight rapidly, are serious physical complications, as noted by the American Heart Association 3
Cardiac complications, which are responsible for at least one-third of all deaths in anorexia nervosa, are a major concern, according to the American College of Cardiology 2

Persistent restriction of energy intake through extreme dietary limitations is a common behavioral pattern, as reported by the Academy of Nutrition and Dietetics 1, 3
Recurrent episodes of binge eating characterized by consuming larger amounts of food than most people would eat in similar circumstances with a sense of lack of control are a symptom of the binge-eating/purging subtype, according to the National Eating Disorders Association 3
Purging behaviors such as self-induced vomiting, misuse of laxatives, diuretics, or other medications are also a symptom of the binge-eating/purging subtype, as noted by the American Psychological Association 3

Adolescent and young adult females between ages 13-20 years are most affected, with a female-to-male ratio of approximately 9:1, according to the American Academy of Pediatrics 2, 3
Adolescent girls involved in competitive sports and dancing face particularly high risk due to performance pressures combined with aesthetic expectations, as reported by the National Athletic Trainers' Association 2
Girls who diet are 18 times more likely to develop an eating disorder than non-dieters, according to the Academy of Nutrition and Dietetics 2

Early detection and immediate medical and psychological treatment are critical, as complications develop rapidly in malnourished adolescents, according to the American Academy of Pediatrics 2
Eating disorder-focused family-based treatment is the recommended approach for adolescents with involved caregivers, as noted by the American Psychological Association 5
Eating disorder-focused cognitive-behavioral therapy (CBT) is recommended for adults, with some evidence that fluoxetine may help prevent relapse in weight-restored patients, according to the National Institute of Mental Health 2, 3