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Anorexia Nervosa Case Study Ppt

Copyright © 2014 Amelia A. Davis and Mathew Nguyen. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Anorexia nervosa (AN) is considered a relatively “modern” disorder; however, a number of scholarly works have cited examples of voluntary self-starvation dating back to several centuries. In particular, there are many examples of female starvation for religious reasons during the medieval period, with many being elevated to sainthood. We present a case of an elderly woman with AN who began restricting her diet when she was 13-years old while studying to be a nun at a Catholic convent. She reports that, during the development of her disease, she had no mirrors and, rather than restricting her diet to be thin or attractive, she restricted her diet to be closer to God in hopes of becoming a Saint. This unique case presents an opportunity to deepen our understanding of AN and the cultural context that affects its development.

1. Introduction

Anorexia nervosa (AN) is a syndrome that is more prevalent in industrialized and western cultures; it is more prevalent among females than males and has a peak age of onset during adolescence [1]. AN appears to have gained more popularity and professional attention over recent decades during a cultural period that idealizes thinness, with magazines publishing significantly more articles on methods for weight loss [2, 3]. Patients with AN are characterized by a disturbed body image in which they often have an intense preoccupation with weight, an intense fear of gaining weight despite having significantly low body weight, or persistent behavior that interferes with weight gain [4]. While once considered a cultural-bound syndrome that occurs almost exclusively in western cultures, a recent review of eating disorders in a cross-cultural and historical context indicates that AN is not a cultural-bound syndrome, although certain features of the disorder appear to be culturally bound, such as fear of weight gain or of becoming fat [5, 6]. AN may take different forms in different cultural and historical contexts with one unifying theme of morbid self-starvation. While previously characterized as a disorder that only occurs in the western cultural idealization of thinness and pressures to lose weight, a review of the literature suggests a long-standing relation between self-starvation and religious asceticism [7–10].

We describe below a contemporary case of an individual whom we treated for AN who developed her eating disorder at the age of 13 while living in a Catholic nunnery, in an environment with few mirrors and without pressure to be thin. She states that her eating disorder began by self-starvation in an attempt to be more pious, and she had hopes of becoming a Saint through asceticism. This unusual case is important to examine as we look at some of the core characteristics of AN, so that we can better understand and treat AN, a deadly illness with a high lifetime mortality rate [1].

2. Case Presentation

“Jane” is a 66-year-old woman who was admitted for treatment of AN that she reported to have begun when she was approximately 13-year old. Jane was raised in a suburb of Chicago and was the oldest of four with three younger brothers. She describes her childhood as happy and denies any history of abuse. She was raised by both her parents; her father was a lithographer and her mother was a home-maker. As the oldest child, Jane states that she was her mother’s “little helper,” and she felt she wanted to do everything to please everybody. She reports having a positive relationship with her father and described him as her “best friend.” She felt that her mother was very busy raising her three younger brothers and felt she favored them over her. When Jane started kindergarten, she describes what may have been separation anxiety and would cry often for her mother. She describes herself as shy and had a few close friends who lived in her neighborhood. In elementary school, she reports being an anxious child; if a nun yelled at the whole class, she would cry. Jane did well in school, had excellent grades, and never missed more than 1-2 days of school.

Jane was raised catholic; her parents attended church every Sunday. When she was in the first grade, she was enrolled in a catholic school and was one of fifty students taught by a nun. In second grade, she began staying after school to help the nuns. One of the nuns took a special interest in her, and over time Jane decided she wanted to become a nun and ultimately a Saint. This never changed as she grew up, and her goal today is to become a Saint. Jane sang in choir and did her prayers excessively starting in 2nd grade. She is not sure how much time she spent on her rituals at the time, but as an adult, she spends over 2 hours per day in a ritualistic and obsessive manner, which included meditating.

Jane was not underweight growing up and states she did not worry about her weight in childhood. She began menarche at about the age of 12 and states she developed early for her age compared to the other girls. When she noticed her breasts developing, she brought it to the attention of her mother who told her “we do not talk like that.” She states that her eating disorder began when she fasted for lent at age of 13 and that she continued fasting after lent. She began losing weight and has had amenorrhea since the age of 13. At the age of 13, she joined the convent to become a nun where she continued to restrict her caloric intake. Joining the convent was what Jane perceived as her decision. In fact, she remembers her father was initially against her joining the convent but was told by their priest that if her father did not allow Jane to join the convent, then he was standing in the way of her occupation and he would go to hell. She left her family and moved several hours away, only seeing her family every other month during her adolescence.

At that convent, Jane lived in a dorm-room with about 20 girls, with curtains separating the cells. She states that it was strict; they could only talk at certain times, but she thought the convent was wonderful as she had friends with the same goals as hers. In the convent, Jane continued to restrict her caloric intake. Meals were served “family style,” and the girls were required to eat everything they took on their plate. Jane would take less food, though she does not recall how much she ate, and would finish everything on her plate. She recalls that the nuns would tell the girls that they could choose to make a sacrifice and take a smaller cookie or that they could be perfect and choose to go without a cookie, something Jane often did. She states that there were no full-length mirrors, and she only had a small mirror to put her habit on. There were also no scales and she is unaware of how much she weighed at the time.

During her adolescence, the convent underwent some major changes. Between about 1962 and 1965, the second Vatican council began addressing issues between the Roman Catholic Church and the modern world. Jane’s supervisors began monitoring what she ate and asked her to see a psychiatrist. She did not understand why she needed to do this as she thought that she was being pious by restricting what she ate. At the age of 21, she left the convent as directed by her supervisors because of concerns about her low body weight. She was told that her practices were “too extreme” and it was “God’s will” for her to leave the convent.

A few months after leaving the convent, Jane started nursing school and later married at the age of 25. She states that this was a culture shock for her as she lived in a co-ed dorm with pharmacy and medical students as well as nursing students. At the age of 21, she did not know even basic information about sexual intercourse and reproductive health. At this time Jane was very thin; she was 5 feet 0 inches and weighed about 75 pounds with a body mass index (BMI) of 14.6 kg/m2.

After she was married, she had difficulty conceiving and was seen by an endocrinologist who instructed her that if she gained weight, she may be able to have a baby. During this time, she tried eating more normally in an attempt to have a baby, and she reached her highest lifetime weight of 92 pounds (BMI of 18.0 kg/m2). She states that, for most of her life, she weighed less than 80 pounds (BMI of 15.6 kg/m2) which is considered to be severely underweight. She states that they later adopted three children and stopped trying to conceive after 7 years of infertility.

Jane was first treated for AN at the age of 30 years in 1976 and then not again until the age of 52 years in 1998. She has been previously treated 12 times in either residential or inpatient treatment facilities for eating disorder and had been working with an outpatient eating disorder treatment team that consisted of a psychiatrist, a nutritionist, and a therapist. She has had nasogastric (NG) tube placements multiple times and has tried multiple different psychotropic medications, including fluvoxamine 100 mg by mouth daily, started to treat comorbid obsessive compulsive disorder (OCD). She denies any history of binge-eating, laxative abuse, diuretic use, or diet pill use. She reports that, in addition to restricting her caloric intake, she exercises compulsively and does Pilates or aerobics 2 hours in the morning, about 3 hours of gardening, and 1-2 hours of walking around her house. Jane states that, in the past, she was able to recover “easily” from her low body weight, but as she has aged, she has had elevated liver function tests. Her comorbid medical conditions include gastroesophageal reflux, osteoporosis, macular degeneration, chronic obstructive pulmonary disease, and hypothyroidism. She denies any family psychiatric history. She denies an family psychiatric history or any personal history of alcohol or recreational drug use. She was working as a registered nurse up until her admission.

On admission, her weight was 60 pounds, her height was 4′10′′, and she had a BMI of 12.5 kg/m2. She had elevated AST of 460 U/L and elevated ALT of 745 U/L that resolved with treatment and weight restoration and was presumed to be secondary to malnutrition. She also had hyponatremia with sodium of 129 and leukopenia with a WBC of 2.3 mill/cu mm that also resolved. She was mildly anemic with hemoglobin of 11.6 g/dL and hematocrit of 24.5%, which also resolved with weight restoration. She reported some depression and grief since the passing of her husband 5 years ago. She also reported thoughts of wanting to be with her deceased husband in heaven, but denied any active suicidal thoughts due to her religious beliefs. She also endorsed OCD symptoms with compulsive religious rituals, compulsive exercising, and body checking. She stated that she still strives for Sainthood. She was treated in the inpatient eating disorder unit for a total of 50 days, and her weight improved to 80.8 lbs with a BMI 16.6 kg/m2.

During her treatment, Jane participated in group therapy that incorporated cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT), and expression therapy including art and yoga therapy. She also worked with an individual therapist and in family therapy that involved her adult adoptive children. In individual therapy, treatment included therapy that incorporated her spiritual beliefs while also challenging some of her religious beliefs (e.g., restriction as being a part of her eating disorder rather than part of her religious beliefs). Interestingly, as treatment progressed, Jane acknowledged that some component of her eating disorder did involve fat phobia and a desire to be thin and that she was not engaging in her behavior purely for religious reasons. She stated that the idea of weighing more than 80 pounds was “terrifying” to her. She had body image disturbance and would often pinch the skin around her abdomen to check for body fat. Over one year later since she left treatment, she continues to work with her outpatient treatment team, remains underweight, but has remained healthy enough to stay out of the hospital.

3. Discussion

Jane had no full-length mirrors or scales, did not know her weight, and did not count calories when she first developed her eating disorder. She states that she began losing weight to be more holy.

While this is unusual for contemporary women with AN, there have been multiple publications that indicate voluntary self-starvation found throughout history and in different sociocultural contexts [7–10]. In the Christian context, there are multiple examples of girls who fasted to the point of death and were even elevated to Sainthood. Termed anorexia mirabilis, this is different from anorexia nervosa in that anorexia mirabilis is associated with other ascetic practices such as flagellations and life-long virginity rather than starvation to achieve thinness, which is currently associated with modern AN [10]. Another main difference is that the behaviors of those with anorexia mirabilis were viewed at the time within a religious context and were not considered a disease [10].

One example of a girl (St. Wilgefortis) elevated to sainthood after self-starvation occurred sometime between 700 A.D. and 900 A.D. Her father, the King of Portugal, was going to force her to marry a suitor, though the girl had made a vow of virginity and service to God. Upon news of her engagement, she prayed that she be stripped of all her beauty and refused nourishment. She lost her feminine contours, and hair grew all over her body. Her suitor withdrew his offer of matrimony. The girl was crucified by her father in punishment. She became the Patron Saint for those who wish to be relieved from the problems associated with procreation or even those under control of others. With time, she became known as one who had liberated herself from the physical and social burdens of womankind [8].

Another example is of Saint Catherine of Siena who began lengthy meditations, reportedly cut her hair, ate very little, and forced herself to vomit the little she had ingested. She also flagellated herself in imitation of Christ’s passion. She died at the age of 32 from malnutrition. She was a model for later religious fasters [9].

Between the 13th and 17th century, mostly in southern Europe, there were 181 cases of holy fasting described, and there are numerous examples of women fasting to the point of death. It was thought that they had direct communication with God in addition to this being a means of avoiding arranged marriages and childbirth [9].

It is interesting that so many of the holy fasters were young women and not men. Many of the women were elevated to a higher social status and even achieved fame, something that would not have occurred had they become wives and mothers. There is some discussion whether anorexia mirabilis represents a historical continuation of AN or whether it is an entirely separate entity. While it is unlikely that they are the same thing, AN and anorexia mirabilis certainly represent a long line of females who use their bodies and food as a symbolic language.

Miraculous fasting continued throughout the seventeenth and eighteenth centuries and cases of these “miraculous maids,” as they were called at the time, brought skepticism and wonder, and clergymen, physicians, and civil magistrates would conduct around-the-clock investigations, sometimes resulting in the death of the girls when the extreme fasting was taken too far [7, 10]. Often they came from poor families and became local attractions with visitors who brought gifts and money [7, 10].

Those who are unfamiliar with the history of AN may be surprised to learn that AN was first described in the 19th century prior to mass media and cultural pressures to diet and the perception that thin is beautiful. AN was first described in the late 19th century almost simultaneously by Leseque in France and Gull in England in 1873. [7] The young females were described as having a “delirious conviction that they cannot or ought not to eat” [7] and who presented with oppositional behaviors as well as an obsession with food [7]. Physicians were cautioned to remove the patient from her family for forced feeding. Both Gull and Leseque described, in addition to refusal to eat, onset in early adulthood or adolescence, restlessness, amenorrhea, and lack of concern from the part of the patient over her worsening condition. They also were rather optimistic regarding the prognosis if the patient is removed from the family who may interfere with treatment. The diagnosis of AN in the 19th century did not appear to include body image disturbance or fear of being fat [7].

The case of Jane is a hybrid between anorexia mirabilis and AN in the sense that, while occurring in modern time, her reasons for voluntary self-starvation and the cultural context in which she was raised are more similar to those individuals described in history as having anorexia mirabilis or miraculous maids. By examining some of the similarities and differences, one can understand more deeply the core criteria of AN. Jane’s presentation is similar in many ways to modern AN. For one, she developed her eating disorder at the age of 13 during puberty, which is in the peak age of onset for AN [1]. She also is highly perfectionistic and has comorbid anxiety disorders including OCD, which has a higher prevalence rate in AN [1]. She also has had amenorrhea since the age of 13 and meets the DSM-5 criteria for AN (has persistent restriction of intake resulting in significantly low body weight, persistent behavior that interferes with weight gain, and persistent lack of recognition of seriousness of current low body weight). She also reported body image disturbance later on in treatment and was overly concerned about fat around her abdomen, despite being extremely thin and even expressed extreme concern and fear of weighing more than 80 pounds. She also had health consequences of osteoporosis and elevated liver function enzymes, which is seen in severe malnutrition.

There are some particularly unusual aspects of the case: one being that she was removed from the family environment from the age of 13 and had little contact with her parents after the age of 13. Another somewhat unusual aspect of this case is the age of the patient and her high functioning status despite being underweight for her entire adulthood. Jane worked as an RN for over 40 years, was married, and adopted 3 children that she helped to raise. While she had health consequences including osteoporosis and possibly liver changes as a result of malnutrition, overall, she appeared to be in relatively fair health, not having suffered as many health consequences as one might expect.

One must be careful not to state that fasting causes AN, similarly to the fact that dieting does not cause AN, as this does not appear to be the case. Still fasting may be a trigger or risk factor for AN, but this would need to be examined more carefully.

In some ways, her religious views both helped her in terms of her resilience as well as impeded in her journey to recovery. This case also shows the importance of examining the patient’s perceived causes of the eating disorder. One important aspect for Jane is to examine and help her gain insight into which of her perceived religious beliefs actually have a spiritual basis and which are more based in her eating disorder mentality. For instance, during treatment, she was encouraged not to engage in excessive religious rituals in the morning, and she reduced the length of these rituals from 2 hours each day to 1 hour each day. She was encouraged to examine what purpose the rituals truly served her. Her treatment would for instance be very different from a patient who presented stating she had started having her eating disorder to achieve thinness or in order to be healthier.

While the reasons for triggering the disorder are different, there are strong similarities between them, certain core traits, such as a high degree of perfectionism, a need for self-control, and a lack of insight into the severity of their illness and/or the seriousness of their low body weight. While one should be careful not to apply a modern diagnosis such as AN to a historical context such as medieval Saints, one can see how an individual might have symptoms of an eating disorder that manifests similarly to the medieval Saints and in an attempt to emulate the Catholic Saints. In reviewing the historical perspective of AN, one also gains a better appreciation of how a mental illness can manifest itself differently in different cultural and historical contexts and yet the core symptomatology remains strikingly similar. This case, therefore, is an argument against that theory that AN is a “culturally bound disease,” a concept that, while refuted by psychiatrists, is still possibly misinterpreted by the public today. AN, a multifactorial disease, is influenced by genetic, biological, social, and cultural factors and is not solely a product of western culture. This unique case offers depth to our understanding of the development of AN and shows how multiple sociocultural influences can affect its development.


The authors have not received any financial support. They have no financial ties to disclose.

Conflict of Interests

The authors declare that there is no conflict of interests regarding the publication of this paper.

  • Miller KK, Grinspoon SK, Ciampa J, Hier J, Herzog D, Klibanski A. Medical findings in outpatients with anorexia nervosa. Arch Intern Med. 2005 Mar 14. 165(5):561-6. [Medline].

  • Cinkajzlova A, Lacinova Z, Klouckova J, Kavalkova P, Trachta P, Kosak M, et al. Angiopoietin-like protein 6 in patients with obesity, type 2 diabetes mellitus, and anorexia nervosa: The influence of very low-calorie diet, bariatric surgery, and partial realimentation. Endocr Res. 2016 May 2. 1-9. [Medline].

  • 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. 2007 Jun. 48(6):552-60. [Medline].

  • Morris J, Twaddle S. Anorexia nervosa. BMJ. 2007 Apr 28. 334(7599):894-8. [Medline].

  • Waller G. Recent advances in psychological therapies for eating disorders. F1000Res. 2016. 5:[Medline].

  • Flament MF, Bissada H, Spettigue W. Evidence-based pharmacotherapy of eating disorders. Int J Neuropsychopharmacol. 2011 Mar 18. 1-19. [Medline].

  • Hay PJ, Claudino AM. Clinical psychopharmacology of eating disorders: a research update. Int J Neuropsychopharmacol. 2011 Mar 25. 1-14. [Medline].

  • Katzman DK, Peebles R, Sawyer SM, Lock J, Le Grange D. The role of the pediatrician in family-based treatment for adolescent eating disorders: opportunities and challenges. J Adolesc Health. 2013 Oct. 53(4):433-40. [Medline].

  • Kaplan H, Sadock B. Fleischer GR, Ludwig S, eds. Synopsis of Psychiatry. 8th ed. Williams and Wilkins; 1998. 720-727.

  • American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. 5th ed. Washington, DC: APA Press; 2013.

  • Elran-Barak R, Accurso EC, Goldschmidt AB, Sztainer M, Byrne C, Le Grange D. Eating patterns in youth with restricting and binge eating/purging type anorexia nervosa. Int J Eat Disord. 2014 Apr 29. [Medline].

  • Forman S. Eating Disorders: epidemiology, pathogenesis, and clinical features. Up to Date [online]. 2005:[Full Text].

  • Hoek HW, van Hoeken D. Review of the prevalence and incidence of eating disorders. Int J Eat Disord. 2003 Dec. 34(4):383-96. [Medline].

  • Treasure J, Claudino AM, Zucker N. Eating disorders. Lancet. 2010 Feb 13. 375(9714):583-93. [Medline].

  • APA. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: APA; 1994.

  • Swanson SA, Crow SJ, Le Grange D, Swendsen J, Merikangas KR. Prevalence and correlates of eating disorders in adolescents: results from the national comorbidity survey replication adolescent supplement. Arch Gen Psychiatry. 2011 Jul. 68(7):714-23. [Medline].

  • Arun CP. Drive for leanness, anorexia nervosa, and overactivity: the missing link. Ann N Y Acad Sci. 2008 Dec. 1148:526-9. [Medline].

  • Facchini M, Sala L, Malfatto G, Bragato R, Redaelli G, Invitti C. Low-K+ dependent QT prolongation and risk for ventricular arrhythmia in anorexia nervosa. Int J Cardiol. 2006 Jan 13. 106(2):170-6. [Medline].

  • Golden NH. Eating disorders in adolescence: what is the role of hormone replacement therapy?. Curr Opin Obstet Gynecol. 2007 Oct. 19(5):434-9. [Medline].

  • Taylor C, Lamparello B, Kruczek K, Anderson EJ, Hubbard J, Misra M. Validation of a food frequency questionnaire for determining calcium and vitamin D intake by adolescent girls with anorexia nervosa. J Am Diet Assoc. 2009 Mar. 109(3):479-85, 485.e1-3. [Medline].

  • Macías-Robles MD, Perez-Clemente AM, Maciá-Bobes C, Alvarez-Rueda MA, Pozo-Nuevo S. Prolonged QT interval in a man with anorexia nervosa. Int Arch Med. 2009 Jul 31. 2(1):23. [Medline]. [Full Text].

  • LE Grange D. The Maudsley family-based treatment for adolescent anorexia nervosa. World Psychiatry. 2005 Oct. 4(3):142-6. [Medline]. [Full Text].

  • Lilenfeld LR, Kaye WH, Greeno CG, et al. A controlled family study of anorexia nervosa and bulimia nervosa: psychiatric disorders in first-degree relatives and effects of proband comorbidity. Arch Gen Psychiatry. 1998 Jul. 55(7):603-10. [Medline].

  • Ammaniti M, Lucarelli L, Cimino S, D'Olimpio F, Chatoor I. Maternal psychopathology and child risk factors in infantile anorexia. Int J Eat Disord. 2010 Apr. 43(3):233-40. [Medline].

  • Button E, Aldridge S. Season of birth and eating disorders: patterns across diagnoses in a specialized eating disorders service. Int J Eat Disord. 2007 Jul. 40(5):468-71. [Medline].

  • Sokol MS, Carroll AK, Heebink DM, Hoffman-Rieken KM, Goudge CS, Ebers DD. Anorexia nervosa in identical triplets. CNS Spectr. 2009 Mar. 14(3):156-62. [Medline].

  • Nilsson EW, Gillberg C, Råstam M. Familial factors in anorexia nervosa: a community-based study. Compr Psychiatry. 1998 Nov-Dec. 39(6):392-9. [Medline].

  • Trace SE, Baker JH, Peñas-Lledó E, Bulik CM. The genetics of eating disorders. Annu Rev Clin Psychol. 2013. 9:589-620. [Medline].

  • Steiger H, Richardson J, Schmitz N, et al. Association of trait-defined, eating-disorder sub-phenotypes with (biallelic and triallelic) 5HTTLPR variations. J Psychiatr Res. 2009 Sep. 43(13):1086-94. [Medline].

  • Wade TD, Gillespie N, Martin NG. A comparison of early family life events amongst monozygotic twin women with lifetime anorexia nervosa, bulimia nervosa, or major depression. Int J Eat Disord. 2007 Sep 14. 40(8):679-686. [Medline].

  • Wade TD, Treloar SA, Heath AC, Martin NG. An examination of the overlap between genetic and environmental risk factors for intentional weight loss and overeating. Int J Eat Disord. 2009 Sep. 42(6):492-7. [Medline]. [Full Text].

  • Grice DE, Halmi KA, Fichter MM, et al. Evidence for a susceptibility gene for anorexia nervosa on chromosome 1. Am J Hum Genet. 2002 Mar. 70(3):787-92. [Medline].

  • Stergioti E, Deligeoroglou E, Economou E, Tsitsika A, Dimopoulos KD, Daponte A, et al. Gene receptor polymorphism as a risk factor for BMD deterioration in adolescent girls with anorexia nervosa. Gynecol Endocrinol. 2013 Jul. 29(7):716-9. [Medline].

  • Kaye W. Neurobiology of anorexia and bulimia nervosa. Physiol Behav. 2008 Apr 22. 94(1):121-35. [Medline]. [Full Text].

  • Bosanac P, Norman T, Burrows G, Beumont P. Serotonergic and dopaminergic systems in anorexia nervosa: a role for atypical antipsychotics?. Aust N Z J Psychiatry. 2005 Mar. 39(3):146-53. [Medline].

  • Fetissov SO, Harro J, Jaanisk M, et al. Autoantibodies against neuropeptides are associated with psychological traits in eating disorders. Proc Natl Acad Sci U S A. 2005 Oct 11. 102(41):14865-70. [Medline].

  • Galle J, Kirsch S, Kaufman M. Anorexia nervosa in a patient with congenital adrenal hyperplasia. J Pediatr Endocrinol Metab. 2013. 26(1-2):167-72. [Medline].

  • Toulany A, Katzman DK, Kaufman M, Hiraki LT, Silverman ED. Chicken or the Egg: Anorexia Nervosa and Systemic Lupus Erythematosus in Children and Adolescents. Pediatrics. 2014 Jan 6. [Medline].

  • Smink FR, van Hoeken D, Hoek HW. Epidemiology of eating disorders: incidence, prevalence and mortality rates. Curr Psychiatry Rep. 2012 Aug. 14(4):406-14. [Medline]. [Full Text].

  • Mehler PS, Gray MC, Schulte M. Medical complications of anorexia nervosa. J Womens Health. 1997 Oct. 6(5):533-41. [Medline].

  • Preti A, Girolamo Gd, Vilagut G, Alonso J, Graaf Rd, Bruffaerts R, et al. The epidemiology of eating disorders in six European countries: results of the ESEMeD-WMH project. J Psychiatr Res. 2009 Sep. 43(14):1125-32. [Medline].

  • Steinhausen HC. Outcome of eating disorders. Child Adolesc Psychiatr Clin N Am. 2009 Jan. 18(1):225-42. [Medline].

  • Wallier J, Vibert S, Berthoz S, Huas C, Hubert T, Godart N. Dropout from inpatient treatment for anorexia nervosa: critical review of the literature. Int J Eat Disord. 2009 Nov. 42(7):636-47. [Medline].

  • National Institute of Mental Health. Collaborative Psychiatric Epidemiology Surveys (CPES). Collaborative Psychiatric Epidemiology Surveys. Available at http://www.icpsr.umich.edu/CPES/. Accessed: October 30, 2007.

  • Fernandes NH, Crow SJ, Thuras P, Peterson CB. Characteristics of black treatment seekers for eating disorders. Int J Eat Disord. 2010 Apr. 43(3):282-5. [Medline].

  • Raevuori A, Hoek HW, Susser E, Kaprio J, Rissanen A, Keski-Rahkonen A. Epidemiology of anorexia nervosa in men: a nationwide study of Finnish twins. PLoS ONE. 2009. 4(2):e4402. [Medline].

  • Feldman MB, Meyer IH. Childhood abuse and eating disorders in gay and bisexual men. Int J Eat Disord. 2007 Jul. 40(5):418-23. [Medline].

  • Isomaa R, Isomaa AL, Marttunen M, Kaltiala-Heino R, Björkqvist K. The prevalence, incidence and development of eating disorders in Finnish adolescents-a two-step 3-year follow-up study. Eur Eat Disord Rev. 2009 May. 17(3):199-207. [Medline].

  • Lavelle JM. Adolescent emergencies. Fleischer GR, Ludwig S, eds. Textbook of Pediatric Emergency Medicine. Philadelphia: Lippincott Williams & Wilkins; 1993. 166(12): 1503-1526.

  • Wentz E, Gillberg IC, Anckarsäter H, Gillberg C, Rastam M. Adolescent-onset anorexia nervosa: 18-year outcome. Br J Psychiatry. 2009 Feb. 194(2):168-74. [Medline].

  • Speranza M, Loas G, Wallier J, Corcos M. Predictive value of alexithymia in patients with eating disorders: A 3-year prospective study. J Psychosom Res. 2007 Oct. 63(4):365-71. [Medline].

  • Steinhausen HC. The outcome of anorexia nervosa in the 20th century. Am J Psychiatry. 2002 Aug. 159(8):1284-93. [Medline].

  • Franko DL, Keel PK, Dorer DJ, Blais MA, Delinsky SS, Eddy KT. What predicts suicide attempts in women with eating disorders?. Psychol Med. 2004 Jul. 34(5):843-53. [Medline].

  • Holm-Denoma JM, Witte TK, Gordon KH, et al. Deaths by suicide among individuals with anorexia as arbiters between competing explanations of the anorexia-suicide link. J Affect Disord. 2008 Apr. 107(1-3):231-6. [Medline].

  • Halmi KA. Anorexia nervosa: an increasing problem in children and adolescents. Dialogues Clin Neurosci. 2009. 11(1):100-3. [Medline].

  • Crow SJ, Peterson CB, Swanson SA, Raymond NC, Specker S, Eckert ED, et al. Increased mortality in bulimia nervosa and other eating disorders. Am J Psychiatry. 2009 Dec. 166(12):1342-6. [Medline].

  • Witte TK, Merrill KA, Stellrecht NE, Bernert RA, Hollar DL, Schatschneider C, et al. "Impulsive" youth suicide attempters are not necessarily all that impulsive. J Affect Disord. 2008 Apr. 107(1-3):107-16. [Medline].

  • Woolrich RA, Cooper MJ, Turner HM. Metacognition in patients with anorexia nervosa, dieting and non-dieting women: a preliminary study. Eur Eat Disord Rev. 2008 Jan. 16(1):11-20. [Medline].

  • Modan-Moses D, Yaroslavsky A, Kochavi B, Toledano A, Segev S, Balawi F, et al. Linear growth and final height characteristics in adolescent females with anorexia nervosa. PLoS One. 2012. 7(9):e45504. [Medline]. [Full Text].

  • Kaplan AS, Walsh BT, Olmsted M, Attia E, Carter JC, Devlin MJ, et al. The slippery slope: prediction of successful weight maintenance in anorexia nervosa. Psychol Med. 2009 Jun. 39(6):1037-45. [Medline].

  • Sylvester CJ, Forman SF. Clinical practice guidelines for treating restrictive eating disorder patients during medical hospitalization. Curr Opin Pediatr. 2008 Aug. 20(4):390-7. [Medline].

  • Forman SF, Grodin LF, Graham DA, Sylvester CJ, Rosen DS, Kapphahn CJ, et al. An eleven site national quality improvement evaluation of adolescent medicine-based eating disorder programs: predictors of weight outcomes at one year and risk adjustment analyses. J Adolesc Health. 2011 Dec. 49(6):594-600. [Medline].

  • Kaye WH, Bulik CM, Thornton L, Barbarich N, Masters K. Comorbidity of anxiety disorders with anorexia and bulimia nervosa. Am J Psychiatry. 2004 Dec. 161(12):2215-21. [Medline].

  • Jordan J, Joyce PR, Carter FA, McIntosh VV, Luty SE, McKenzie JM, et al. The Yale-Brown-Cornell eating disorder scale in women with anorexia nervosa: what is it measuring?. Int J Eat Disord. 2009 Apr. 42(3):267-74. [Medline].

  • Bryant-Waugh R, Knibbs J, Fosson A, Kaminski Z, Lask B. Long term follow up of patients with early onset anorexia nervosa. Arch Dis Child. 1988 Jan. 63(1):5-9. [Medline].

  • Björkenstam E, Björkenstam C, Holm H, Gerdin B, Ekselius L. Excess cause-specific mortality in in-patient-treated individuals with personality disorder: 25-year nationwide population-based study. Br J Psychiatry. 2015 Oct. 207 (4):339-45. [Medline].

  • Kask J, Ekselius L, Brandt L, Kollia N, Ekbom A, Papadopoulos FC. Mortality in Women With Anorexia Nervosa: The Role of Comorbid Psychiatric Disorders. Psychosom Med. 2016 Apr 29. [Medline].

  • Treasure J, Nazar BP. Interventions for the Carers of Patients With Eating Disorders. Curr Psychiatry Rep. 2016 Feb. 18 (2):16. [Medline].

  • Arcelus J, Mitchell AJ, Wales J, Nielsen S. Mortality Rates in Patients With Anorexia Nervosa and Other Eating Disorders: A Meta-analysis of 36 Studies. Arch Gen Psychiatry. 2011 Jul. 68(7):724-31. [Medline].

  • Støving RK, Hangaard J, Hansen-Nord M, Hagen C. A review of endocrine changes in anorexia nervosa. J Psychiatr Res. 1999 Mar-Apr. 33(2):139-52. [Medline].

  • Matzkin V, Slobodianik N, Pallaro A, Bello M, Geissler C. Risk factors for cardiovascular disease in patients with anorexia nervosa. Int J Psychiatr Nurs Res. 2007 Sep. 13(1):1531-45. [Medline].

  • Vázquez M, Olivares JL, Fleta J, Lacambra I, González M. [Cardiac disorders in young women with anorexia nervosa]. Rev Esp Cardiol. 2003 Jul. 56(7):669-73. [Medline].

  • Morse JL, Safdar B. Acute tension pneumothorax and tension pneumoperitoneum in a patient with anorexia nervosa. J Emerg Med. 2010 Apr. 38(3):e13-6. [Medline].

  • Verhoef PA, Rampal A. Unique challenges for appropriate management of a 16-year-old girl with superior mesenteric artery syndrome as a result of anorexia nervosa: a case report. J Med Case Rep. 2009 Nov 16. 3:127. [Medline]. [Full Text].

  • Nicholls DE, Lynn R, Viner RM. Childhood eating disorders: British national surveillance study. Br J Psychiatry. 2011 Apr. 198(4):295-301. [Medline].

  • Price C, Schmidt MA, Adam EJ, Lacey H. Parotid gland enlargement in eating disorders: an insensitive sign?. Eat Weight Disord. 2008 Dec. 13(4):e79-83. [Medline].

  • Sterling WM, Golden NH, Jacobson MS, Ornstein RM, Hertz SM. Metabolic assessment of menstruating and nonmenstruating normal weight adolescents. Int J Eat Disord. 2009 Nov. 42(7):658-63. [Medline].

  • Wade TD, Frayne A, Edwards SA, Robertson T, Gilchrist P. Motivational change in an inpatient anorexia nervosa population and implications for treatment. Aust N Z J Psychiatry. 2009 Mar. 43(3):235-43. [Medline].

  • Ziora K, Ziora D, Oswiecimska J, et al. Spirometric parameters in malnourished girls with anorexia nervosa. J Physiol Pharmacol. 2008 Dec. 59 suppl 6:801-7. [Medline].

  • Birgegård A, Björck C, Norring C, Sohlberg S, Clinton D. Anorexic self-control and bulimic self-hate: differential outcome prediction from initial self-image. Int J Eat Disord. 2009 Sep. 42(6):522-30. [Medline].

  • Hrabosky JI, Cash TF, Veale D, et al. Multidimensional body image comparisons among patients with eating disorders, body dysmorphic disorder, and clinical controls: a multisite study. Body Image. 2009 Jun. 6(3):155-63. [Medline].

  • Kawai K, Yamanaka T, Yamashita S, et al. Somatic and psychological factors related to the body mass index of patients with anorexia nervosa. Eat Weight Disord. 2008 Dec. 13(4):198-204. [Medline].

  • Jordan J, Joyce PR, Carter FA, et al. Specific and nonspecific comorbidity in anorexia nervosa. Int J Eat Disord. 2008 Jan. 41(1):47-56. [Medline].

  • Morgan JF, Reid F, Lacey JH. The SCOFF questionnaire: assessment of a new screening tool for eating disorders. BMJ. 1999 Dec 4. 319(7223):1467-8. [Medline].

  • Altinyazar V, Kiylioglu N, Salkin G. Anorexia nervosa and Wernicke Korsakoff's syndrome: atypical presentation by acute psychosis. Int J Eat Disord. 2010 Dec. 43(8):766-9. [Medline].

  • Kreipe RE, Birndorf SA. Eating disorders in adolescents and young adults. Med Clin North Am. 2000 Jul. 84(4):1027-49, viii-ix. [Medline].

  • Nicholls D, Viner R. Eating disorders and weight problems. BMJ. 2005 Apr 23. 330(7497):950-3. [Medline].

  • Jones ER, Morgan JF, Arcelus J. Managing physical risk in anorexia nervosa. Adv Psychiatrist Treat. 2013. 19:201-2.

  • Puxley F, Midtsund M, Iosif A, Lask B. PANDAS anorexia nervosa--endangered, extinct or nonexistent?. Int J Eat Disord. 2008 Jan. 41(1):15-21. [Medline].

  • Roberts CM, Martin-Clavijo A, Winston AP, Dharmagunawardena B, Gach JE. Malnutrition and a rash: think zinc. Clin Exp Dermatol. 2007 Nov. 32(6):654-7. [Medline].

  • Toulany A, Katzman DK, Kaufman M, Hiraki LT, Silverman ED. Chicken or the egg: anorexia nervosa and systemic lupus erythematosus in children and adolescents. Pediatrics. 2014 Feb. 133(2):e447-50. [Medline].

  • Ward L, Tricco AC, Phuong P, et al. Bisphosphonate therapy for children and adolescents with secondary osteoporosis. Cochrane Database Syst Rev. 2007 Oct 17. CD005324. [Medline].

  • Coxson HO, Chan IH, Mayo JR, Hlynsky J, Nakano Y, Birmingham CL. Early emphysema in patients with anorexia nervosa. Am J Respir Crit Care Med. 2004 Oct 1. 170(7):748-52. [Medline].

  • Lesinskiene S, Barkus A, Ranceva N, Dembinskas A. A meta-analysis of heart rate and QT interval alteration in anorexia nervosa. World J Biol Psychiatry. 2007 Apr 5. 1-6. [Medline].

  • Gowers SG. Management of eating disorders in children and adolescents. Arch Dis Child. 2008 Apr. 93(4):331-4. [Medline].

  • Muscari M. Effective management of adolescents with anorexia and bulimia. J Psychosoc Nurs Ment Health Serv. 2002 Feb. 40(2):22-31. [Medline].

  • Schwartz BI, Mansbach JM, Marion JG, Katzman DK, Forman SF. Variations in admission practices for adolescents with anorexia nervosa: a North American sample. J Adolesc Health. 2008 Nov. 43(5):425-31. [Medline].

  • Golden NH. Variability in admission practices for teens hospitalized with anorexia nervosa: a call for evidence-based outcome studies. J Adolesc Health. 2008 Nov. 43(5):417-8. [Medline].

  • Divasta AD, Feldman HA, Beck TJ, Leboff MS, Gordon CM. Does hormone replacement normalize bone geometry in adolescents with anorexia nervosa?. J Bone Miner Res. 2014 Jan. 29(1):151-7. [Medline]. [Full Text].

  • Herpertz-Dahlmann B, Salbach-Andrae H. Overview of treatment modalities in adolescent anorexia nervosa. Child Adolesc Psychiatr Clin N Am. 2009 Jan. 18(1):131-45. [Medline].

  • Tchanturia K, Larsson E, Brown A. Benefits of group cognitive remediation therapy in anorexia nervosa: case series. Neuropsychiatr. 2016 Mar. 30 (1):42-49. [Medline].

  • Higgins J, Hagman J, Pan Z, MacLean P. Increased physical activity not decreased energy intake is associated with inpatient medical treatment for anorexia nervosa in adolescent females. PLoS One. 2013. 8(4):e61559. [Medline]. [Full Text].

  • Rio A, Whelan K, Goff L, Reidlinger DP, Smeeton N. Occurrence of refeeding syndrome in adults started on artificial nutrition support: prospective cohort study. BMJ Open. 2013 Jan 11. 3(1):[Medline]. [Full Text].

  • Rigaud D, Brondel L, Poupard AT, Talonneau I, Brun JM. A randomized trial on the efficacy of a 2-month tube feeding regimen in anorexia nervosa: A 1-year follow-up study. Clin Nutr. 2007 Aug. 26(4):421-9. [Medline].

  • Mehler PS, Winkelman AB, Andersen DM, Gaudiani JL. Nutritional rehabilitation: practical guidelines for refeeding the anorectic patient. J Nutr Metab. 2010. 2010:[Medline]. [Full Text].

  • Krantz MJ, Mehler PS. Resting tachycardia, a warning sign in anorexia nervosa: case report. BMC Cardiovasc Disord. 2004 Jul 16. 4:10. [Medline].

  • Jagielska G, Tomaszewicz-Libudzic EC, Brzozowska A. Pellagra: a rare complication of anorexia nervosa. Eur Child Adolesc Psychiatry. 2007 Oct. 16(7):417-20. [Medline].

  • Garber AK, Michihata N, Hetnal K, Shafer MA, Moscicki AB. A prospective examination of weight gain in hospitalized adolescents with anorexia nervosa on a recommended refeeding protocol. J Adolesc Health. 2012 Jan. 50(1):24-9. [Medline].

  • Kyriacou O, Treasure J, Schmidt U. Expressed emotion in eating disorders assessed via self-report: an examination of factors associated with expressed emotion in carers of people with anorexia nervosa in comparison to control families. Int J Eat Disord. 2008 Jan. 41(1):37-46. [Medline].

  • Lock J, Le Grange D, Agras WS, Moye A, Bryson SW, Jo B. Randomized clinical trial comparing family-based treatment with adolescent-focused individual therapy for adolescents with anorexia nervosa. Arch Gen Psychiatry. 2010 Oct. 67(10):1025-32. [Medline].

  • Fisher CA, Hetrick SE, Rushford N. Family therapy for anorexia nervosa. Cochrane Database Syst Rev. 2010. 4:CD004780. [Medline].

  • Bergh C, Brodin U, Lindberg G, Sodersten P. Randomized controlled trial of a treatment for anorexia and bulimia nervosa. Proc Natl Acad Sci U S A. 2002 Jul 9. 99(14):9486-91. [Medline].

  • Lock J, Fitzpatrick KK. Anorexia nervosa. Clin Evid (Online). 2009 Mar 10. 2009:[Medline].

  • Harper K, Richter NL, Gorey KM. Group work with female survivors of childhood sexual abuse: evidence of poorer outcomes among those with eating disorders. Eat Behav. 2009 Jan. 10(1):45-8. [Medline].

  • Wild B, Friederich HC, Gross G, Teufel M, Herzog W, Giel KE, et al. The ANTOP study: focal psychodynamic psychotherapy, cognitive-behavioural therapy, and treatment-as-usual in outpatients with anorexia nervosa--a randomized controlled trial. Trials. 2009 Apr 23. 10:23. [Medline].

  • Bowers WA, Ansher LS. The effectiveness of cognitive behavioral therapy on changing eating disorder symptoms and psychopathology of 32 anorexia nervosa patients at hospital discharge and one year follow-up. Ann Clin Psychiatry. 2008 Apr-Jun. 20(2):79-86. [Medline].

  • McIntosh VV, Jordan J, Carter FA, et al. Three psychotherapies for anorexia nervosa: a randomized, controlled trial. Am J Psychiatry. 2005 Apr. 162(4):741-7. [Medline].

  • Geist R, Heinmaa M, Stephens D, et al. Comparison of family therapy and family group psychoeducation in adolescents with anorexia nervosa. Can J Psychiatry. 2000 Mar. 45(2):173-8. [Medline].

  • Ehrlich S, Burghardt R, Schneider N, Broecker-Preuss M, Weiss D, Merle JV, et al. The role of leptin and cortisol in hyperactivity in patients with acute and weight-recovered anorexia nervosa. Prog Neuropsychopharmacol Biol Psychiatry. 2009 Jun 15. 33(4):658-662. [Medline].

  • Thien V, Thomas A, Markin D, Birmingham CL. Pilot study of a graded exercise program for the treatment of anorexia nervosa. Int J Eat Disord. 2000 Jul. 28(1):101-6. [Medline].

  • Davenport L. New Eating Disorder Guidelines Released. Medscape Medical News. Available at http://www.medscape.com/viewarticle/835980. Accessed: December 6, 2014.

  • Hay P, Chinn D, Forbes D, Madden S, Newton R, Sugenor L, et al. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of eating disorders. Aust N Z J Psychiatry. 2014 Nov. 48(11):977-1008. [Medline].

  • Reinblatt SP, Redgrave GW, Guarda AS. Medication management of pediatric eating disorders. Int Rev Psychiatry. 2008 Apr. 20(2):183-8. [Medline].

  • Kishi T, Kafantaris V, Sunday S, Sheridan EM, Correll CU. Are antipsychotics effective for the treatment of anorexia nervosa? Results from a systematic review and meta-analysis. J Clin Psychiatry. 2012 Jun. 73(6):e757-66. [Medline].

  • Wildes JE, Marcus MD, Gaskill JA, Ringham R. Depressive and manic-hypomanic spectrum psychopathology in patients with anorexia nervosa. Compr Psychiatry. 2007 Sep-Oct. 48(5):413-8. [Medline].

  • Ramoz N, Versini A, Gorwood P. Eating disorders: an overview of treatment responses and the potential impact of vulnerability genes and endophenotypes. Expert Opin Pharmacother. 2007 Sep. 8(13):2029-44. [Medline].

  • Cooper WO, Callahan ST, Shintani A, et al. Antidepressants and suicide attempts in children. Pediatrics. 2014 Feb. 133(2):204-10. [Medline]. [Full Text].

  • McKnight RF, Park RJ. Atypical antipsychotics and anorexia nervosa: a review. Eur Eat Disord Rev. 2010 Jan. 18(1):10-21. [Medline].

  • Szmukler GI, Young GP, Miller G, Lichtenstein M, Binns DS. A controlled trial of cisapride in anorexia nervosa. Int J Eat Disord. 1995 May. 17(4):347-57. [Medline].

  • Tchanturia K, Doris E, Mountford V, Fleming C. Cognitive Remediation and Emotion Skills Training (CREST) for anorexia nervosa in individual format: self-reported outcomes. BMC Psychiatry. 2015 Mar 20. 15:53. [Medline].

  • Attia E, Kaplan AS, Walsh BT, Gershkovich M, Yilmaz Z, Musante D, et al. Olanzapine versus placebo for out-patients with anorexia nervosa. Psychol Med. 2011 Oct. 41 (10):2177-82. [Medline].

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