Which clinical history findings are characteristic of anorexia nervosa?

Updated: Jun 10, 2019
  • Author: Bettina E Bernstein, DO; Chief Editor: Caroly Pataki, MD  more...
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Answer

Obtain the patient's history with the goal of developing a treatment plan rather than with the objective of merely ruling out an eating disorder.

A study by Nicholls et al found that about 21% of individuals with a childhood eating disorder had early feeding difficulties that predated the disorder’s diagnosis. In the study, the incidence of eating disorders was 3 per 100,000 youth; of that group, the criteria for anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified were met by 37%, 1.4%, and 43% of individuals, respectively. [78]

A psychological profile for a patient with anorexia nervosa often demonstrates premorbid anxiety disorders, as well as more severe affective disorders, such as major depression and dysthymic disorder. Patients may also have symptoms of obsessive-compulsive disorder, with rigid and ritualistic eating behaviors. The study by Nicholls and colleagues found that of 208 individuals who met the criteria for an eating disorder, 41% had significant comorbidity (other psychiatric diagnoses) and 44% had a family history of psychiatric disorders. [78, 56, 57, 79, 80, 81, 82]

Pay careful attention to the patient's self-image and self-esteem, even if the patient identifies that he or she has an eating disorder. This may help to stratify the risk of mortality, which is 18 times higher when anorexia nervosa is comorbid with significant psychiatric disorders such as major depressive disorder. Patients should be asked about early morning awakening, tearfulness, and thoughts of suicide or a plan for it.

It is also important to focus on self-image in the treatment of anorexia nervosa because control-submission interactions between patient and therapist must be handled with care. [44, 83]

This interview can also help to identify an increased risk of dropping out from inpatient treatment. For example, the presence of anxiety or other mental health conditions can help to predict a response to treatment and assess motivation for changing behavior.

With medical assessment, focus on the medical complications of altered nutrition. Seek a careful history detailing weight changes, dietary patterns, and excessive exercise. Determine weight and height. [83] Low body mass index (BMI) often relates to preexisting body dysmorphic disorder. [84, 85] The presence or absence of self-induced vomiting/binge eating and laxative use should also be ascertained.


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