Anorexia Nervosa: Core Features, Medical Complications, and Treatment Imperative

Anorexia nervosa (AN) is a severe eating disorder characterized by energy restriction relative to requirements, intense fear of weight gain, and body image disturbance (DSM-5). It has the highest mortality of any psychiatric illness.

Diagnostic Triad

• Restriction: Intake insufficient for age/sex/developmental trajectory → significantly low weight (BMI <18.5 adult; <5th %ile pediatric).
• Fear of fatness: Persistent, not alleviated by weight loss.
• Body distortion: Undue influence of weight/shape on self-evaluation; denial of seriousness.

Subtypes: Restricting type vs. Binge-eating/purging type.

Medical Complications (Multi-System)

Treatment Framework

1. Medical stabilization (inpatient if BMI <15, unstable vitals, electrolyte derangements, suicide risk).
2. Nutritional rehabilitation: Gradual refeeding (avoid refeeding syndrome), weight restoration target.
3. Psychotherapy: FBT (first-line adolescents), CBT-E (adults), specialist supportive clinical management.
4. Psychopharmacology: Limited evidence; olanzapine for anxiety/weight gain; SSRIs not effective acutely.
5. Long-term: Relapse prevention, body image work, comorbid treatment.

Early intervention by an eating disorder specialty team saves lives. Recovery is possible but requires sustained, expert care.

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System	Complications
Cardiac	Bradycardia, hypotension, QT prolongation, arrhythmia, atrophy → sudden death risk
Endocrine	Hypogonadotropic hypogonadism (amenorrhea), low T3, cortisol dysregulation, bone loss (osteoporosis)
GI	Gastroparesis, constipation, superior mesenteric artery syndrome, hepatic steatosis
Electrolyte	Hypokalemia, hypomagnesemia, hypophosphatemia (refeeding syndrome risk)
Hematologic	Anemia, leukopenia, thrombocytopenia (marrow hypoplasia)
Neurologic	Brain volume loss (partially reversible), cognitive rigidity, peripheral neuropathy