From the Guidelines
Physical exam findings to confirm anorexia nervosa include a comprehensive review of systems, assessment of vital signs, and evaluation of physical appearance, including signs of malnutrition or purging behaviors, as recommended by the American Psychiatric Association (1). To confirm anorexia nervosa, the physical exam should include:
- Assessment of vital signs, including temperature, resting heart rate, blood pressure, orthostatic pulse, and orthostatic blood pressure
- Evaluation of height, weight, and BMI (or percent median BMI, BMI percentile, or BMI Z-score for children and adolescents)
- Examination of physical appearance, including signs of malnutrition or purging behaviors
- Patients typically present with emaciation, loss of muscle mass, and subcutaneous fat, as well as common signs such as lanugo, dry skin, brittle hair and nails, cold intolerance, and peripheral edema
- Vital signs may reveal bradycardia, hypotension, and hypothermia, as noted in the American Psychiatric Association practice guideline (1) The laboratory assessment should include a complete blood count and a comprehensive metabolic panel, including electrolytes, liver enzymes, and renal function tests, as recommended by the APA (1). It's essential to note that diagnosis requires both physical and psychological assessment, as the condition involves both severe malnutrition and characteristic psychological disturbances around body weight and shape, and patients with anorexia nervosa should have a documented, comprehensive, culturally appropriate, and person-centered treatment plan (1).
From the Research
Physical Exam Findings
To confirm anorexia nervosa, several physical exam findings can be observed, including:
- Lower left ventricular mass (LVM) and systolic dysfunction 2
- Smaller left ventricular chamber dimension and thinner chamber walls 2
- Lower ejection fraction, heart rate, stroke volume, and cardiac output 2
- Higher peripheral resistance 2
- Lower systolic blood pressure 3, 4
- Lower heart rate at peak exercise 4
- Abnormal working capacity and cardiovascular responses to exercise 4
- Alterations in autonomic control of heart rate variability, including relative sympathetic failure and prevalent vagal activity 5
- Cardiovascular vagal hyperactivity, influencing ventricular diastolic dynamics 6
Cardiovascular Findings
Cardiovascular findings in patients with anorexia nervosa include:
- Lower heart rate variability (HRV) time domain indices 6
- Lower LF/HF ratio in the frequency domain 6
- Reduced left ventricular mass with normal systolic function 6
- Typical diastolic patterns, characterized by a lower peak velocity transmitral flow in late diastole and a greater E/A ratio 6
Other Findings
Other physical exam findings in patients with anorexia nervosa include: