- An eating disorder characterized by the restriction of food intake leading to significantly low weight with intense fear of weight gain
- Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), divides anorexia into two types:
- Restricting type: not engaged in binge eating or purging behaviors (last 3 months)
- Binge eating/purging type: regularly engaged in binge eating or purging behaviors (last 3 months)
- System(s) affected: nervous, cardiovascular, endocrine, metabolic, pulmonary, gastrointestinal, reproductive, ophthalmic, taste, and dermatologic
- Severity of anorexia nervosa (AN) is based on BMI (per DSM-5):
- Mild: BMI ≥17 kg/m2
- Moderate: BMI 16.00 to 16.99 kg/m2
- Severe: BMI 15.00 to 15.99 kg/m2
- Extreme: BMI <15 kg/m2
- Predominant age: 15 to 24 years
- Predominant sex: female > male (10:1 to 20:1 female-to-male ratio)
- 0.9–2.0% in women (1.1–3.0% in young females)
- 0.1–0.3% in men (higher in gay and bisexual men)
Etiology and Pathophysiology
- Complex relationships among genetic, biologic, environmental, psychological, and social factors that result in the development of this disorder
- Parenting style that leads to high expectation may result in children struggle for control.
- Serotonin, norepinephrine, and dopamine neuronal systems are implicated.
- Evidence of higher concordance rates in monozygotic than in dizygotic twins
- First-degree female relative with eating disorder increases risk 6- to 10-fold.
- One genome-wide significant locus identified for AN on chromosome 12
- Female gender
- Body dissatisfaction, negative self-evaluation
- Perfectionism, high parental demands, academic pressure, severe life stressors
- History of sexual or physical abuse
- Participation in sports or activities that emphasize leanness: ballet, figure skating, gymnastics, cheerleading
- Type 1 diabetes mellitus
- Family history of substance abuse, affective disorders, or eating disorders
Prevention programs can reduce risk factors and future onset of eating disorders.
- Target adolescents and young women ≥15 years of age.
- Encourage realistic and healthy weight management strategies and attitudes.
- Promote self-esteem.
- Reduce focus on thin as ideal.
- Decrease co-occurring anxiety/depressive symptoms and improve stress management.
Commonly Associated Conditions
- Suicide, mood and anxiety disorders
- Substance use disorder
- Cluster C personality disorder
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Domino, Frank J., et al., editors. "Anorexia Nervosa." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2020. www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/1688841/all/Anorexia_Nervosa.
Anorexia Nervosa. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2020. https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/1688841/all/Anorexia_Nervosa. Accessed June 4, 2023.
Anorexia Nervosa. (2020). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (27th ed.). Wolters Kluwer. https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/1688841/all/Anorexia_Nervosa
Anorexia Nervosa [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2020. [cited 2023 June 04]. Available from: https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/1688841/all/Anorexia_Nervosa.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Anorexia Nervosa ID - 1688841 ED - Domino,Frank J, ED - Baldor,Robert A, ED - Golding,Jeremy, ED - Stephens,Mark B, BT - 5-Minute Clinical Consult, Updating UR - https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/1688841/all/Anorexia_Nervosa PB - Wolters Kluwer ET - 27 DB - 5-Minute Clinical Consult DP - Unbound Medicine ER -