Anorexia nervosa is an eating disorder in which a person restricts food and reaches a dangerously low weight, driven by intense fear of gaining weight and a distorted body image. It has one of the highest death rates of any mental illness, from heart rhythm problems, starvation and suicide.
Key symptoms
- Strict dieting, skipping meals, rituals around food
- Intense fear of weight gain and seeing oneself as too big
- Excessive exercise, sometimes vomiting or laxative use
- Missed periods, feeling cold, dizziness, constipation
- Social withdrawal, low mood, anxiety
What you find on exam
- Weight, height and BMI, or percent of expected weight in teens
- Slow heart rate, low blood pressure, orthostatic changes, low temperature
- Dry skin, fine body hair (lanugo), cold hands
- Swollen salivary glands or calluses on knuckles if purging
Tests
- Electrolytes, phosphate, magnesium, glucose
- ECG: slow rate and long QT interval
- Blood count, liver and kidney tests, thyroid tests
- Bone density scan if low weight for more than 6 months
Treatment basics
- Team care: medical provider, dietitian and therapist
- Nutritional rehabilitation with gradual calorie increase
- Family-based treatment for teens; cognitive behavioral therapy for adults
- Watch phosphate, potassium and magnesium daily early in refeeding
- Hospital care if unstable vital signs or very low weight
Red flags
- Heart rate under 50 when awake, fainting or blood pressure under 90/45
- Low potassium or phosphate, or arrhythmia on ECG
- Suicidal thoughts or refusal of all food
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.