From the Guidelines
The workup for anorexia involves a comprehensive approach combining physical, psychological, and laboratory assessments, as recommended by the American Psychiatric Association (1). Initially, a detailed medical history and physical examination should be performed to identify potential underlying causes and assess the severity of malnutrition. Laboratory tests should include:
- Complete blood count
- Comprehensive metabolic panel, including electrolytes, liver enzymes, and renal function tests (1)
- Thyroid function tests
- Urinalysis
- Electrocardiogram to evaluate for electrolyte abnormalities and cardiac complications (1) Psychological evaluation is essential, focusing on eating patterns, body image concerns, and screening for comorbid conditions like depression or anxiety. For suspected anorexia nervosa specifically, diagnostic criteria from established guidelines should be applied, assessing for intentional weight loss, intense fear of gaining weight, and disturbance in body image perception. Depending on findings, additional tests may include:
- Bone density scans to assess for osteoporosis
- Nutritional deficiency panels
- Brain imaging if neurological symptoms are present The severity of malnutrition determines the appropriate level of care, ranging from outpatient treatment to hospitalization for severe cases with medical instability. APA recommends (1C) that patients with an eating disorder have a documented, comprehensive, culturally appropriate, and person-centered treatment plan that incorporates medical, psychiatric, psychological, and nutritional expertise, commonly via a coordinated multidisciplinary team (1). This comprehensive approach is necessary because anorexia can have multiple causes, from psychological disorders to underlying medical conditions, and can lead to serious complications including cardiac problems, electrolyte imbalances, and even death if left untreated. Key aspects of the treatment plan for anorexia nervosa include:
- Individualized goals for weekly weight gain and target weight (1)
- Eating disorder-focused psychotherapy for adults (1)
- Family-based treatment for adolescents and emerging adults with an involved caregiver (1)
From the Research
Work-up for Anorexia
The work-up for anorexia nervosa involves a comprehensive evaluation of the patient's physical and psychological condition.
- Initial evaluation: The primary care physician plays a critical role in recognizing anorexia nervosa and diagnosing its medical complications 2.
- Laboratory tests: Laboratory studies can help diagnose anorexia nervosa and determine the degree of medical compromise, but normal values do not rule out the condition 3.
- Physical examination: A thorough physical examination is essential to identify potential complications, such as hypotension, osteopenia, and life-threatening arrhythmias 4.
- Psychological evaluation: A psychological evaluation is crucial to assess the patient's mental health and identify comorbid psychiatric disorders, such as depression 4.
Diagnostic Criteria
The Diagnostic and Statistical Manual of Mental Disorders, 5th ed., includes updated diagnostic criteria for anorexia nervosa, such as the elimination of amenorrhea as a diagnostic criterion 4.
- The diagnosis of anorexia nervosa is based on a combination of physical and psychological factors, including low body mass index (BMI), fear of gaining weight, and distorted body image 5.
Treatment Options
Treatment for anorexia nervosa typically involves a multidisciplinary approach, including:
- Family-based treatment: Helpful for adolescents with anorexia nervosa 4.
- Psychotherapy: Cognitive behavior therapy is effective for most patients with bulimia nervosa, but its use in anorexia nervosa is limited 4.
- Medications: Antidepressant medications may be beneficial for patients with bulimia nervosa, but their use in anorexia nervosa is limited 4.
- Refeeding: A careful refeeding plan is essential to prevent complications, such as electrolyte abnormalities and liver function test abnormalities 6.