Anorexia Nervosa
Basics
Description
- An eating disorder characterized by the restriction of food intake leading to significantly low weight with intense fear of weight gain and distorted perception of body weight and shape
- Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) divides anorexia into two types:
- Restricting type: characterized by restricting intake of calories or extreme amounts of exercise without binge-eating and purging behaviors within the last 3 months
- Binge-eating/purging type: regular engagement in binge intake or purging behaviors within the past 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; severe is <15 kg/m2.
Epidemiology
Prevalence
- Estimated lifetime prevalence among U.S. adults of 0.5%
- Median age of onset age: 17 years
- Predominant sex: female > male (10:1 to 20:1 female-to-male ratio)
Etiology and Pathophysiology
- Complex relationships among genetic, biologic, environmental, psychological, and social factors that result in the development of this disorder
- Serotonin, norepinephrine, and dopamine neuronal systems are implicated.
Genetics
- Aggregates in families—11-fold risk among female relatives of a proband with the disorder
- Evidence of high concordance rates in monozygotic than in dizygotic twins
- GWAS study showing 8 loci exceeding genome wide significance on chromosomes 1, 3, 10, and 11.
Risk Factors
- Body dissatisfaction, negative self-evaluation
- Perfectionism, high parental demands, academic pressure, severe life stressors
- History of sexual or physical abuse or parental maltreatment
- 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
General Prevention
Prevention programs for adolescents and young women ≥15 years can reduce risk factors and future onset of eating disorders.
- 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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Citation
Domino, Frank J., et al., editors. "Anorexia Nervosa." 5-Minute Clinical Consult, 33rd ed., Wolters Kluwer, 2025. Medicine Central, im.unboundmedicine.com/medicine/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; 2025. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688841/all/Anorexia_Nervosa. Accessed December 12, 2024.
Anorexia Nervosa. (2025). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (33rd ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/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; 2025. [cited 2024 December 12]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688841/all/Anorexia_Nervosa.
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