From the Guidelines
Physical examination findings in a young patient with active anorexia nervosa typically include emaciation with visible bone prominences, significant weight loss, and loss of subcutaneous fat, as well as vital sign abnormalities such as bradycardia, hypotension, hypothermia, and orthostatic changes, as recommended by the American Psychiatric Association (1). The patient may also exhibit skin changes, including lanugo, dry skin, brittle hair and nails, and yellowish skin discoloration. Cardiovascular examination may reveal a mitral valve prolapse murmur or arrhythmias, while musculoskeletal findings include muscle wasting, weakness, and decreased bone density. Neurological examination may demonstrate decreased deep tendon reflexes, and gastrointestinal findings include abdominal distention, delayed gastric emptying, and constipation. Parotid gland enlargement may be present, especially in patients who purge. These physical findings result from the body's adaptation to starvation and malnutrition, with systems slowing down to conserve energy in the face of inadequate nutritional intake, as noted in the American Psychiatric Association practice guideline for the treatment of patients with eating disorders (1). However, it's worth noting that the most recent and highest quality evidence is from the American Psychiatric Association practice guideline (1), which provides a comprehensive overview of the diagnosis and treatment of eating disorders, including anorexia nervosa. Some older studies, such as the one published in Pediatrics (1), may provide additional context on the prevalence of eating disorders in children and adolescents, but the American Psychiatric Association guideline (1) is the most relevant and up-to-date source for information on the physical examination findings in patients with anorexia nervosa. Key points to consider in the physical examination of a patient with anorexia nervosa include:
- Vital sign abnormalities, such as bradycardia, hypotension, and hypothermia
- Skin changes, including lanugo and dry skin
- Cardiovascular findings, such as mitral valve prolapse murmur or arrhythmias
- Musculoskeletal findings, including muscle wasting and decreased bone density
- Neurological findings, such as decreased deep tendon reflexes
- Gastrointestinal findings, including abdominal distention and delayed gastric emptying.
From the Research
Physical Examination Findings in Anorexia Nervosa
The physical examination findings in a young patient with active anorexia nervosa can be diverse and affect multiple systems. Some of the common findings include:
- Dermatological changes such as xerosis (71% of patients) 2, cheilitis (76%) 2, bodily hypertrichosis (62%) 2, alopecia (24%) 2, dry scalp hair (48%) 2, acral coldness (38%) 2, acrocyanosis (33%) 2, periungual erythema (48%) 2, gingival changes (37%) 2, nail changes (29%) 2, and calluses on the dorsum of the hand due to self-induced vomiting (67%) 2
- Cardiovascular findings such as orthostatic changes 3 and QTc prolongation 3
- Musculoskeletal findings such as bone mineral density (BMD) loss 3
- Neurological findings such as brain volume deficits 3
- Other findings such as hypokalaemia 3, hypoglycaemia 3, and Russell's sign (knuckle calluses) due to vomiting 4
Dermatological Signs
Dermatological signs are almost always detectable in patients with severe anorexia nervosa and bulimia nervosa 4. These signs can include:
- Xerosis
- Lanugo-like body hair
- Telogen effluvium
- Carotenoderma
- Acne
- Hyperpigmentation
- Seborrheic dermatitis
- Acrocyanosis
- Perniosis
- Petechiae
- Livedo reticularis
- Interdigital intertrigo
- Paronychia
- Generalized pruritus
- Acquired striae distensae
- Slower wound healing
- Prurigo pigmentosa
- Edema
- Linear erythema craquele
- Acral coldness
- Pellagra
- Scurvy
- Acrodermatitis enteropathica
These signs can be used to aid in the early diagnosis of anorexia nervosa and other eating disorders 4.