Anorexia nervosa (AN) is an eating disorder characterized by a fear of gaining weight, strong desire to be thin, and food restriction, which results in low weight. It is the highest mortality psychiatric illness with a mortality rate of 10%.
Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected.
RID
of their weight” can be used to remember the core features of anorexia.R
- Restriction of intake leading to significantly low body weightI
- Intense fear of weight gainD
- Disturbance in perception of one's weight or body imageIntense fear of gaining weight or of becoming fat, or persistent behaviour that interferes with weight gain, even though at a significantly low weight.
Disturbance in the way in which one's bodyweight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.
3
months, the individual has not engaged in recurrent episodes of binge eating or purging behaviour (i.e. - self-induced vomiting or the misuse of laxatives, diuretics, or enemas). This subtype describes presentations in which weight loss is accomplished primarily through dieting, fasting, and/or excessive exercise.3
months, the individual has engaged in recurrent episodes of binge eating or purging behaviour (i.e. - self-induced vomiting or the misuse of laxatives, diuretics, or enemas).Specify if:
Criterion A
(low body weight) has not been met for a sustained period, but either Criterion B
(intense fear of gaining weight or becoming fat or behavior that interferes with weight gain) or Criterion C
(disturbances in self-perception of weight and shape) is still met. The minimum level of severity is based, for adults, on current body mass index (BMI) (see below) or, for children and adolescents, on BMI percentile. The ranges below are derived from World Health Organization (WHO) categories for thinness in adults; for children and adolescents, corresponding BMI percentiles should be used. The level of severity may be increased to reflect clinical symptoms, the degree of functional disability, and the need for supervision.
Criterion A
or anorexia nervosa is met, the clinician needs to consider not just the numerical guidelines, but also the individual's body build, weight history, and any physiological changes (e.g. - amenorrhea).[12]Name | Rater | Description | Download |
---|---|---|---|
Eating Disorder Diagnostic Scale (EDDS) | Patient | A 22-item self-report scale for individuals between 13 to 65 years old that screens for anorexia nervosa, bulimia nervosa, and binge-eating disorder. | Link |
2
or more positive answers should raise your index of suspicion of a case, highlighting need for more detailed history.
3
month period?Other possible causes of either significantly low body weight or significant weight loss should be considered in the differential diagnosis of anorexia nervosa, especially when the presenting features are atypical (e.g., onset after age 40 years).
Once weight-gain has restarted, various forms of psychotherapy have been found to be effective for treatment of anorexia, including:[24][25]
Guideline | Location | Year | Website | |
---|---|---|---|---|
International Comparison (Curr Opin Psychiatry) | International | 2017 | - | Link |
Canadian Clinical Practice Guidelines (Children and Adolescents) | Canada | 2020 | - | Link |
National Institute for Health and Care Excellence (NICE) | UK | 2017 | - | Link |
American Psychiatric Association (APA) | USA | 2006, 2012 | - | • Guideline (2006) • Guideline Watch (2012) • Quick Reference |