Anorexia nervosa patients present physical symptoms as well as behavioural and emotional symptoms.

Physical signs and symptoms of anorexia are [7]:

• Severe weight loss
• Emaciated appearance
• Extreme fatigue
• Insomnia
• Dizziness or fainting
• Bluish discoloration of the fingers
• Weak hair
• Amenorrhea
• Dry skin
• Extreme discomfort in cold conditions
• Bradycardia or tachycardia
• Hypotension
• Dehydration
• Edema
• Osteoporosis

Emotional and behavioural symptoms associated with anorexia nervosa include:

• Rejection of meals
• Hiding hunger
• Excessive fear of gaining weight
• Dishonesty when discussing how much food has been consumed
• Frequent, strenuous, or compulsive exercise
• Signs of social withdrawal
• Constant experimentation with food
• Irritability
• Constant display of uninterest
• Lack of interest in sexual activities
• Use of herbal products, laxatives, etc. 

• Anorexia

  Anorexia nervosa is an eating disorder characterized by a pathological fear of weight gain and usually excessive weight loss. There are two subtypes of anorexia nervosa: restricting type and binge eating–purging type. [symptoma.com]

  Anorexia nervosa Other names Anorexia "Miss A—" depicted in 1866 and in 1870 after treatment. She was one of the earliest case studies of anorexia. From the published medical papers of Sir William Gull. [en.wikipedia.org]

  OBJECTIVE: The aim of this paper was to analyze medical utilization patterns of female patients with anorexia nervosa before their first inpatient care visit for anorexia nervosa using the National Health Insurance Research Database (NHIRD) of Taiwan. [ncbi.nlm.nih.gov]

• Weight Loss

  Anorexia nervosa is a medical and psychological disorder classically seen in young women who present with significant weight loss, a distorted body image, and an intense fear of gaining weight despite being underweight. [ncbi.nlm.nih.gov]

• Underweight

  Persons with anorexia nervosa have low body weight and distorted body image, and often deny that they are dangerously underweight. [jamanetwork.com]

  Intense fear of gaining weight or becoming fat, even though underweight. [nationaleatingdisorders.org]

  These patients also may carry a heavier psychological burden than those who are underweight, due to heightened preoccupations with food avoidance and more negative feelings about body shape and weight. [sciencedaily.com]

  Anorexia nervosa is a medical and psychological disorder classically seen in young women who present with significant weight loss, a distorted body image, and an intense fear of gaining weight despite being underweight. [ncbi.nlm.nih.gov]

• Malnutrition

  Malnutrition, Severe Weight Loss, Extreme Weight Loss) Progression of Anorexia Nervosa (Self-Starvation, Malnutrition, Severe Weight Loss, Extreme Weight Loss) Symptoms of Anorexia Nervosa (Self-Starvation, Malnutrition, Severe Weight Loss, Extreme [myvmc.com]

  Pathology was consistent with liver injury secondary to severe malnutrition rather than from refeeding syndrome. [ncbi.nlm.nih.gov]

• Anemia

  Other medical complications included pericardial tamponade that was treated with an open window pericardiocentesis, hepatitis, and anemia. [ncbi.nlm.nih.gov]

  Other medical conditions may also be present, such as anemia, dry skin and scalp, osteoporosis, lowered body temperature and blue fingertips, and slow thinking due to brain shrinkage. [emilyprogram.com]

  […] dull, and dry hair, skin, and nails Cold intolerance/hypothermia Fatigue/dizziness/fainting Abuse of laxatives, diet pills, and/or diuretics Excessive and compulsive exercise regimes Control issues Sleep difficulties (May Include) Low blood pressure Anemia [allianceforeatingdisorders.com]

  Hematological (blood): About one-third of anorexic adolescents have mild anemia (low red blood cell count). Leukopenia (low white blood cell count) occurs in up to 50 percent of anorexic adolescents. [childrenshospital.org]

• Vomiting

  Self-induced vomiting and purging are secondary devices used by the patients to counteract the effects of overeating and prevent a gain in weight. [ncbi.nlm.nih.gov]

  Fainting Dizziness Confusion Shortness of breath Profuse vomiting or diarrhea Blood in vomit or diarrhea Chest pain Abdominal pain Weakness Severe dehydration Often the doctor may choose to admit a person with anorexia to the hospital for a variety of [emedicinehealth.com]

  Purging —The use of vomiting, diuretics, or laxatives to clear the stomach and intestines after a binge. Russell's sign —A scraped or raw area on the patient's knuckles, caused by self-induced vomiting. [healthofchildren.com]

• Constipation

  Makes frequent comments about feeling “fat” or overweight despite weight loss Complains of constipation, abdominal pain, cold intolerance, lethargy, and/or excess energy Denies feeling hungry Develops food rituals (e.g., eating foods in certain orders [nationaleatingdisorders.org]

  They include: Anaemia (iron deficiency) Compromised immune system (e.g. getting sick more often) Intestinal problems (e.g. abdominal pain, constipation, diarrhoea) Loss or disturbance of menstruation in girls and women Increased risk of infertility in [nedc.com.au]

  GI 1.Constipation 2.Decreased intestinal mobility 3.Delayed gastric emptying 4.Gastric dilation and rupture(from binge eating and purging) can lead to pneumothorax and pneumoperitoneum 25. [slideshare.net]

• Abdominal Pain

  pain headaches or problems sleeping feeling cold, dizzy or very tired poor circulation in hands and feet dry skin, hair loss from the scalp, or fine downy hair (lanugo) growing on the body reduced sex drive People with anorexia often have other mental [www2.hse.ie]

  Makes frequent comments about feeling “fat” or overweight despite weight loss Complains of constipation, abdominal pain, cold intolerance, lethargy, and/or excess energy Denies feeling hungry Develops food rituals (e.g., eating foods in certain orders [nationaleatingdisorders.org]

  pain Hormones – irregular or absent periods, loss of libido, infertility Kidneys – dehydration, kidney failure Bones and muscles – loss of bone calcium (osteopenia), osteoporosis, muscle loss, weakness, fatigue Read more Recovery and treatment It is [eatingdisorders.org.au]

  They include: Anaemia (iron deficiency) Compromised immune system (e.g. getting sick more often) Intestinal problems (e.g. abdominal pain, constipation, diarrhoea) Loss or disturbance of menstruation in girls and women Increased risk of infertility in [nedc.com.au]

• Loss of Appetite

  Extreme weight loss in people with anorexia nervosa can lead to dangerous health problems and even death. The term anorexia literally means "loss of appetite." [my.clevelandclinic.org]

  The term anorexia nervosa has both Greek and Latin roots: an meaning no, and orexis meaning appetite, both from Greek, and nervosa from Latin, meaning nervous – in other words, loss of appetite due to psychological reasons. [irishtimes.com]

  The word anorexia literally means loss of appetite but that's not necessarily what happens to someone who has it. In fact, their appetite is just suppressed while they develop a really intense interest in food. [spunout.ie]

• Nausea

  Apart from inducing nausea, high PYY levels were also found to be associated with decreased body weight, body mass index and bone composition in subjects with anorexia. [garvan.org.au]

  […] any mental disorder. (1, 5 ) Starvation is a major cause of death, but one in five anorexia deaths is due to suicide. (4,2) Other complications include: Organ damage Anemia Heart problems Bone loss Stomach issues, such as bloating, constipation, or nausea [everydayhealth.com]

  […] prolapse, abnormal heart rhythms or heart failure Bone loss (osteoporosis), increasing the risk of fractures Loss of muscle In females, absence of a period In males, decreased testosterone Gastrointestinal problems, such as constipation, bloating or nausea [mayoclinic.org]

  Stopping them suddenly can cause problems, such as nausea and constipation Gaining weight safely Your healthcare professional will give you advice on how to increase the amount you eat so you can gain weight safely. [nhsinform.scot]

• Parotid Swelling

  […] mm Hg decrease in systolic BP or a 10 mm Hg decrease in diastolic BP within 3 minutes of standing from a supine position.12 Other notable findings include hypercarotenemia, acrocyanosis, lanugo, dependent edema, breast atrophy, scaphoid abdomen, and parotid [journals.lww.com]

• Hypotension

  Vitals on presentation were notable for hypothermia, hypotension, and bradycardia. Initial exam was significant for emaciation, lethargy, and lower extremity edema. [ncbi.nlm.nih.gov]

  Hypotension and orthostatic change in pulse and blood pressure are key indicators for hospitalization for adolescents with eating disorders. 14 A study by Hudson et al 19 suggests hospitalization when systolic blood pressure is less than 80 mm Hg. [cfp.ca]

  Physical ( for nasogastric resuscitation ) Bradycardia (< 50 bpm) Postural hypotension (fall in systolic BP lying to standing > 20 mmHg) Dehydration Hypothermia (temp. [rch.org.au]

• Tachycardia

  This prolongation, together with the presence of bradycardia, is a risk factor for ventricular arrhythmia due to torsade de pointes polymorphic ventricular tachycardia, and thus constitutes a risk factor for sudden death. [revespcardiol.org]

  […] dysmorphia Along with these, numerous signs may be observed and they include - but are not limited to - the following: lanugo hair and/or alopecia amenorrhea (from suppression of the gonadal axis) dental caries (from purging) orthostatic hypotension or tachycardia [radiopaedia.org]

  Physical signs and symptoms of anorexia are: Severe weight loss Emaciated appearance Extreme fatigue Insomnia Dizziness or fainting Bluish discoloration of the fingers Weak hair Amenorrhea Dry skin Extreme discomfort in cold conditions Bradycardia or tachycardia [symptoma.com]

  Associated arrhythmias include: sinus arrest, wandering atrial pacemakers, nodal escape beats, supraventricular tachycardia, and ventricular tachycardia. [academic.oup.com]

• Orthostatic Hypotension

  hypotension or tachycardia resting bradycardia halitosis lagophthalmos purpurae 2 Central nervous system Complications include global cerebral atrophy, subacute combined degeneration of the cord due to vitamin B 12 deficiency, Wernicke encephalopathy [radiopaedia.org]

  Patients with anorexia nervosa are also more susceptible to orthostatic hypotension, bradycardia, and muscle cramping due to malnutrition and low level caloric diets. [physio-pedia.com]

  CVS 1.Cardiomyopathy 2.Mitral valve prolapse 3.Supraventricular and ventricular dysrhythmias 4.Long QT syndrome 5.Bradycardia 6.Orthostatic hypotension 7.Shock due to congestive heart failure 23. [slideshare.net]

  Consider admission for persistent and recurrent emesis alone (10 to 20 times a day), especially in the face of bradycardia or orthostatic hypotension. [acphospitalist.org]

  During her first 3 days, DX's weight increased to 41.2 kg (90.64 lb) and her orthostatic hypotension and lab results remained stable. On day 3, DX began eating solid nutrition equivalent to 2,000 calories/day. [journals.lww.com]

• Acrocyanosis

  PHYSICAL FEATURES • Cardiac and skeletal systems are most affected • Constipation • Amenorrhea • Vital signs: bradycardia, hypotension, and mild hypothermia • Lanugo hair in back, forearm and cheeks • Salivary gland enlargement • Acrocyanosis of the digits [slideshare.net]

  […] hypotension, bradycardia, hypothermia, and orthostatic changes greater than a 20 mm Hg decrease in systolic BP or a 10 mm Hg decrease in diastolic BP within 3 minutes of standing from a supine position.12 Other notable findings include hypercarotenemia, acrocyanosis [journals.lww.com]

  Examination can be normal but findings could include bradycardia, hypotension, peripheral oedema, gaunt face, lanugo hair, scanty pubic hair, and acrocyanosis (hands or feet are red or purple). [patient.info]

  Involvement Individuals with anorexia nervosa may exhibit but are not limited to the systemic complications listed below: Cardiovascular Complications [2] Bradycardia Orthostatic Hypotension Decreased myocardial contractility Delayed capillary refill Acrocyanosis [physio-pedia.com]

  Dermatological complications include lanugo, acrocyanosis, and thinning hair [10]. [intechopen.com]

• Osteoporosis

  Subchondral insufficiency fracture (SIF) is a fragility fracture secondary to osteoporosis that leads to collapse of the femoral head with no evidence of osteonecrosis. [ncbi.nlm.nih.gov]

  Having an eating disorder, like anorexia nervosa, can increase your risk of osteoporosis and broken bones. [theros.org.uk]

  Weight restoration with re-feeding techniques is essential for prevention of sequelae, such as heart failure, fertility problems, and osteoporosis. Patients are often identified through family intervention and the patient's non-specific complaints. [bestpractice.bmj.com]

• Muscular Atrophy

  She was admitted to a highly specialised eating disorder facility with distended abdomen, muscular atrophy, ulcerative dermatitis, electrolyte derangements and low serum albumin. [ncbi.nlm.nih.gov]

• Lanugo

  INTEGUMENTARY 1.Dry skin and hair 2.Hair loss 3.Lanugo hair/hypertrichosis 27. HEMATOLOGY 1.Anemia 2.Leukopenia 3.Thrombocytopenia 28. REPRODUCTION 1.Infertility 2.Low-birth-weight 29. [slideshare.net]

  […] include: anxiety, mood swings, depression irritable weak, lack of energy dizzy, headaches low blood pressure stomach or intestinal problems low body temperature loss of bone density hair loss or thinning soft, fine hair that grows on the face and body (lanugo [keltyeatingdisorders.ca]

  Muscle loss and weakness Abnormally slow and/or irregular heartbeat Irregular menstruation or Amenorrhea Heart damage Weak or brittle bones/osteoporosis Dehydration/kidney failure Edema (swelling) Memory loss/disorientation Growth of fine, downy hair (lanugo [allianceforeatingdisorders.com]

  […] the risk for osteoporosis/osteopenia increases as bone density decreases Muscle loss and weakness Dehydration (which can result in kidney failure) Fainting, fatigue, and overall weakness Dry hair and skin, hair loss Growth of a downy layer of hair (lanugo [magnolia-creek.com]

  Purging by vomiting or taking laxatives or diuretics • Cooking for others but not eating the food • Feeling sad, anxious or irritable • Feeling cold all the time • Tremendous weight loss • Exhaustion • Dizziness • Fine, soft hair on the body called lanugo [ulifeline.org]

• Dry Skin

  Physical symptoms can include: absence of regular menstrual cycles dry skin low pulse rate, and low blood pressure Behavioral changes commonly occur such as: social withdrawal irritability moodiness, and depression Without treatment, this disorder can [aacap.org]

  Other medical conditions may also be present, such as anemia, dry skin and scalp, osteoporosis, lowered body temperature and blue fingertips, and slow thinking due to brain shrinkage. [emilyprogram.com]

  skin Anorexia can alsobe associated with other psychological problems, such as depression, anxiety, low self-esteem, alcohol misuse, and self-harm. [zana.com]

  Physical signs and symptoms of anorexia are: Severe weight loss Emaciated appearance Extreme fatigue Insomnia Dizziness or fainting Bluish discoloration of the fingers Weak hair Amenorrhea Dry skin Extreme discomfort in cold conditions Bradycardia or [symptoma.com]

• Alopecia

  […] restriction of caloric intake low body weight relative to age, sex and health unjustified fear of weight gain body dysmorphia Along with these, numerous signs may be observed and they include - but are not limited to - the following: lanugo hair and/or alopecia [radiopaedia.org]

  Patients may also suffer from bone loss, dry mouth, low blood pressure, and alopecia. Female patients usually experience missing or stopped periods. All other symptoms characteristic to malnutrition may appear in a person with anorexia nervosa. [bulimia.com]

  […] loss of muscle mass listlessness, fatigue, exhaustion hypotension, or blood pressure lightheadedness or dizziness hypothermia, or low body temperature, and cold hands and feet bloated or upset stomach and constipation dry skin swollen hands and feet alopecia [medicalnewstoday.com]

• Hirsutism

  Common physical findings include bradycardia, low blood pressure, hypothermia, lanugo hair or slight hirsutism, and edema. Body fat is greatly reduced. [merckmanuals.com]

• Low Self-Esteem

  The most common element surrounding ALL Eating Disorders, including Anorexia, is the inherent presence of a low self esteem Anorexia Nervosa Those who are suffering with this illness have a low self-esteem and often a tremendous need to control their [something-fishy.org]

  The causes that may contribute to a person developing anorexia nervosa include: Psychological factors, such as a high level of perfectionism or obsessive-compulsive personality traits, feeling limited control in life and low self-esteem, a tendency towards [healthdirect.gov.au]

  […] and low self-esteem Reluctance to express feelings Warning signs: Extreme weight loss Increasing rigidity of the diet Preoccupation with weight, food or counting calories Wearing multiple layers of clothing Excessive or compulsive exercise Multiple excuses [uclahealth.org]

  As with other eating disorders, anorexia can be associated with depression, low self-esteem, alcohol misuse and self-harm. [beateatingdisorders.org.uk]

• Denial

  Feelings of guilt after eating Denial of severity of low weight High levels of anxiety and/or depression Low self-esteem Self-injury Social isolation Excuses for not eating/denial of hunger Food rituals Intense, dramatic mood swings Pale appearance/yellowish [allianceforeatingdisorders.com]

  […] intake, resulting in significantly low body weight Intense fear of gaining weight or becoming fat (despite significantly low body weight) Disturbance in the experience of body weight or shape; undue influence of weight or shape on self-evaluation, or denial [magnolia-creek.com]

  Self-denial was continued until her planned discharge; however, positive behavioural change was recorded whilst her blood showed normokalaemia for a whole week until her discharge. [ncbi.nlm.nih.gov]

  Disturbance in the experience of body weight or shape, undue influence of weight or shape on self-evaluation, or denial of the seriousness of low body weight. Loss of menstrual periods in girls and women post-puberty. [studenthealth.sa.ucsb.edu]

  Children: less than 85 percent of body weight expected for age and height or failure to gain weight during a growth period, leading to body weight less than 85 percent of that expected Intense fear of gaining weight or becoming fat Body image disturbance Denial [upmc.com]

• Preoccupation with Food

  The Shape and Weight Concern items primarily loaded together on one factor, along with preoccupation with food and fear of losing control over eating, two Eating Concern items. [ncbi.nlm.nih.gov]

  Read Lauren's story Warning signs of anorexia nervosa Some of the more common signs and symptoms of anorexia nervosa are: Preoccupation with body shape, weight and/or appearance Intense fear of gaining weight Preoccupation with food or food related activities [eatingdisorders.org.au]

  The signs and symptoms of anorexia nervosa can include: sudden or significant weight loss sudden or significant reduction in amount of food eaten or in types of foods eaten loss of menstrual period preoccupation with food and weight weight and body shape [healthywa.wa.gov.au]

• Compulsive Behavior

  Also eating disorder-specific cognitions and compulsive behaviors remitted. Previous studies have applied much lower doses and showed no effect of dronabinol upon the urge to be physically active. [ncbi.nlm.nih.gov]

  The restrictive eating behaviors associated with anorexia may therefore result from an imbalance between inhibitory and reward systems, which leads to a shift to compulsive behaviors. [brainblogger.com]

  behavior irritability over-exercising Food and eating become associated with guilt. [medicalnewstoday.com]

• Lethargy

  Initial exam was significant for emaciation, lethargy, and lower extremity edema. Laboratory work-up revealed markedly elevated LFTs, hypoglycemia, thrombocytopenia and elevated INR and lipase. ECG showed sinus bradycardia with prolonged QTc. [ncbi.nlm.nih.gov]

  Makes frequent comments about feeling “fat” or overweight despite weight loss Complains of constipation, abdominal pain, cold intolerance, lethargy, and/or excess energy Denies feeling hungry Develops food rituals (e.g., eating foods in certain orders [nationaleatingdisorders.org]

  […] increased risk of heart failure and death Reduction of bone density (osteopenia and osteoporosis) which results in dry, brittle bones Muscle loss and weakness Severe dehydration, which can result in kidney failure Edema (swelling) Fainting, fatigue, lethargy [livingbreadgreenville.org]

• Amenorrhea

  KEYWORDS: Anorexia nervosa; Bone metabolism; Hypothalamic amenorrhea; Low bone density [ncbi.nlm.nih.gov]

  Amenorrhea: The illness also causes a woman's menstrual cycle to stop, a condition called amenorrhea. Impotence: Men with anorexia often become impotent. [pamf.org]

  Endocrine (hormones): One of the most telling symptoms of anorexia is amenorrhea, or when the menstrual cycle is missed for three or more consecutive cycles without any other underlying cause. [childrenshospital.org]

  It most commonly affects young women and can lead to amenorrhea, malnutrition, brittle bones, and other physiological changes. anorexia nervosa a disorder characterized by a prolonged refusal to eat, resulting in emaciation, amenorrhea, emotional disturbance [medical-dictionary.thefreedictionary.com]

• Kidney Failure

  failure infertile, unable to get pregnant dry, yellow skin joint pain swollen hands or feet insomnia (for girls and women) irregular or no menstrual periods AN can lead to many medical problems. [keltyeatingdisorders.ca]

  failure Edema (swelling) Memory loss/disorientation Growth of fine, downy hair (lanugo) Decreased growth hormone which may lead to delayed physical maturation Decreased estrogen/testosterone/thyroid hormone Infertility Electrolyte imbalance that can [allianceforeatingdisorders.com]

  […] increases as bone density decreases Muscle loss and weakness Dehydration (which can result in kidney failure) Fainting, fatigue, and overall weakness Dry hair and skin, hair loss Growth of a downy layer of hair (lanugo) all over the body, including the [magnolia-creek.com]

  Severe dehydration, which can result in kidney failure. Fainting, fatigue and overall weakness. Dry hair and skin; hair loss. Growth of a downy layer of hair called lanugo all over the body, including the face. [pbs.org]

• Irregular Menstruation

  […] heartbeat Irregular menstruation or Amenorrhea Heart damage Weak or brittle bones/osteoporosis Dehydration/kidney failure Edema (swelling) Memory loss/disorientation Growth of fine, downy hair (lanugo) Decreased growth hormone which may lead to delayed [allianceforeatingdisorders.com]

  […] or irregular menstruation Constipation Irregular heart rhythms Dehydration and electrolyte imbalances Frequent feeling of cold Receiving Anorexia Treatment: What to Do After Recognizing Anorexia Symptoms Eating disorders, especially anorexia, often develop [mccallumplace.com]

  Visible signs that she is starving herself include extreme weight loss, abnormal thinness, brittle nails, hair loss, constipation, irregular menstruation, and swelling. [childmind.org]

  Pale complexion (almost a pasty look) Physical/Medical Complications Fatigue and lack of energy Amenorrhea (loss of menstruation) Skin problems Dizziness and headaches Dehydration Shortness of breath Irregular heartbeats Cold hands and feet Bloating [mirror-mirror.org]

• Secondary Amenorrhea

  Anorexia nervosa Treatment of secondary amenorrhoea and infertility Secondary amenorrhea is a hallmark of anorexia nervosa. [jeatdisord.biomedcentral.com]

  Endocrine symptoms in anorexia nervosa include hypothermia (feeling cold), delayed onset of menses or secondary amenorrhea, and osteopenia progressing to osteoporosis. 11, 12 More than one-half of patients with eating disorders meet criteria for a current [aafp.org]

  The continuous downward spiraling of weight loss then causes secondary amenorrhea and loss of secondary sexual characteristics, further worsening weight loss. [emedicine.medscape.com]

• Sexual Dysfunction

  Partners may become more anxious to conceive, increasing sexual dysfunction.[17] Marital discord often develops, especially when they are under pressure to make medical decisions. [en.wikipedia.org]

Although there is no clear evidence to show that any particular treatment for anorexia nervosa works better than others, evidence shows that early intervention and treatment often prove effective in handling of the condition [9]. In general, anorexia nervosa treatment is focused on addressing these three main areas:

• Restoration of the individual to a healthy weight
• Treatment of psychological disorders related to the ailment
• Reduction or eradication of behaviours responsible for the disorder in the first instance

• Delayed Bone Age

  [medical citation needed] Height potential is normally preserved if the duration and severity of illness are not significant or if the illness is accompanied by delayed bone age (especially prior to a bone age of approximately 15 years), as hypogonadism [en.wikipedia.org]

• Calcium Decreased

  […] little data that supplementation of calcium decreases the risk of fractures.[99] While some meta-analyses have found a benefit of vitamin D supplements combined with calcium for fractures, they did not find a benefit of vitamin D supplements (800 IU/ [en.wikipedia.org]

• Prolonged QT Interval

  Cooke et al9 analyzed the QT interval in 41 adult patients and showed a prolonged QT interval in 15% of the patients, with sudden death occurring in two. [revespcardiol.org]

  An ECG may show bradycardia or a prolonged QT interval in those with more severe anorexia. [patient.info]

  Prolonged QT intervals may increase the risk for cardiac dysrhythmias and sudden death.14,15 The gastrointestinalsystem is affected as well, including possible dysphagia from weakened and uncoordinated pharyngeal muscles, slowed gastric emptying, and [journals.lww.com]

  Some patients have prolonged QT intervals (even when corrected for heart rate), which, with the risks imposed by electrolyte disturbances, may predispose to tachyarrhythmias. Sudden death, most likely due to ventricular tachyarrhythmias, may occur. [merckmanuals.com]

Treatment of this condition requires a physical, social and psychological assessment of the individual by health professionals, especially an eating disorder specialist. This assessment is important to decide the most suitable care plan to follow.

Generally, treatment of the condition will involve a combination of psychological therapy and individually tailored advice on eating and nutrition. This will help the patient gain weight safely.

Psychiatrists, specialist nurses and dietitians contribute at different stages to the treatment of anorexic individuals. The treatment is done on an outpatient basis except in serious cases where the individual must be treated in a hospital or specialist eating disorder clinics.

The prognosis of anorexia nervosa varies. Morbidity rates often range from 10 to 20% with only 50% of patients being able to recover fully. Of the remaining, 20% remain emaciated while another 25% still present thin body. The remaining either dies of starvation or become overweight [6].

However, mortality following complications as a result of starvation is far less frequent in patients with anorexia nervosa as death arising from suicide which is the chief source of mortality incidence. Suicide attempts are higher in people with a history of artificial inducement of physical pain, drug use, and laxative use.

Anorexia nervosa is as a result of a complex interchange between social biologic and psychological factors [3]. It affects more women than men and in women it is mostly seen in adolescents.

Patients who develop anorexia nervosa often display a relatively high incidence of premorbid anxiety disorders. Since most cases of anorexia nervosa are seen within the pubescent years, experts believe that exertion of control over body weight and food consumption is the adolescents attempting to make up for what is seen as absence of selfhood and autonomy.

Some predisposing factors in eating disorders include:

• Female sex
• Difficulty discussing negative emotions
• Low self-esteem
• Family history of any kinds of eating disorders 
• Perfectionistic personality
• Difficulty resolving conflict

Maternal encouragement of weight loss (actively or passively) is also a risk factor for anorexia nervosa especially when the disorder is seen in children. The possibility of genetic predisposition has been pointed out following reported cases of anorexia nervosa in twins and triplets.

In individuals with anorexia nervosa, there is a lifelong incidence of anxiety, depressive disorders as well as obsessive-compulsive disorder. Systemic lupus eythematosus and congenital adrenal hyperplasia are common disorders associated with anorexia nervosa.

The condition is seen in all developed countries and cuts across all socioeconomic classes. It occurs worldwide around the same rates of incidence of 0.3 to 1% in women and 0.1 to 0.3% in men. It is also seen in developing countries like China and Brazil [4].

A standard case of anorexia begins with a young individual mildly overweight or normal weight going on a diet or exercise regime with a plan to lose weight. Following the initial positive results, he or she receives compliments from peers or family. This is deemed high reward by the individual and makes it difficult for them to stop this behaviour as soon as an ideal weight is achieved [5].

Malnutrition as a result of self-starvation brings about protein deficiency and a disruption of multiple organ systems including the cardiovascular, renal, gastrointestinal, neurologic, endocrine, integumentary, reproductive and hematologic systems.

There's no guaranteed way to prevent anorexia nervosa or other forms of eating disorders [10].

Anorexia nervosa refers is an eating disorder where patients try their best to keep their body weight as low as they can [1]. They achieve this by severely restricting the amount of food they eat and vomiting after meals. They also engage in excessive exercising.

This condition develops as a result of anxiety about the shape of the body and weight and fear of becoming fat. Anorexic individuals often have a false image of themselves [2]. This makes they feel they are fat when in reality, they may be perfectly normal.

Anorexia is seen both sexes and peak age for the condition is 16 to 17 years.

Anorexia nervosa refers to an eating disorder which causes people be overly obsessed with their weight and what they consume. In such people, the focus is on trying to maintain body weight that is well below what is deemed normal for their height and age and they achieve this by starving themselves or exercising excessively.
People who have this problem make the mistake of equating thinness with self-worth.

This condition is difficult to overcome but with the right treatment and psychotherapy, the individual can return to a normal eating habit and also reverse any damages already caused by the condition.

1. Miller KK, Grinspoon SK, Ciampa J, Hier J, Herzog D, Klibanski A. Medical findings in outpatients with anorexia nervosa. Arch Intern Med. Mar 14 2005;165(5):561-6.
2. Eisler I, Simic M, Russell GF, Dare C. A randomised controlled treatment trial of two forms of family therapy in adolescent anorexia nervosa: a five-year follow-up. J Child Psychol Psychiatry. Jun 2007;48(6):552-60.
3. Morris J, Twaddle S. Anorexia nervosa. BMJ. Apr 28 2007;334(7599):894-8.
4. Herpertz-Dahlmann B, Salbach-Andrae H. Overview of treatment modalities in adolescent anorexia nervosa. Child Adolesc Psychiatr Clin N Am. Jan 2009;18(1):131-45.
5. E Grange D. The Maudsley family-based treatment for adolescent anorexia nervosa. World Psychiatry. Oct 2005;4(3):142-6.
6. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington, VA 2013.
7. Keel PK, McCormick L. Diagnosis, assessment, and treatment planning for anorexia nervosa. In: TheTreatment of Eating Disorders: A Clinical Handbook, Grilo CM, Mitchell JE (Eds), The Guilford Press, New York 2010. p.3.
8. Andersen, AE, Yager, J. Eating disorders. In: Kaplan and Sadock's Comprehensive Textbook of Psychiatry, Volume I, Ninth Edition, Sadock, BJ, Sadock, VA, Ruiz P (Eds), Lippincott Williams & Wilkins, Philadelphia 2009. p.2128.
9. Weider S, Indredavik MS, Lydersen S, Hestad K. Neuropsychological function in patients with anorexia nervosa or bulimia nervosa. Int J Eat Disord 2014.
10. Hudson JI, Hiripi E, Pope HG Jr, Kessler RC. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol Psychiatry 2007; 61:348.