Anorexia Nervosa

What is anorexia nervosa?

Anorexia nervosa, which is also called anorexia, is a type of eating disorder. It is both a physical and emotional problem that can become life-threatening.

A person who has anorexia severely limits the amount of food he or she eats, has an intense fear of gaining weight, and can become dangerously thin. Severe or long-term anorexia can lead to starvation, serious health problems, and even death.

Anorexia is not dieting. It may start as dieting, but it grows beyond your control. Anorexia is also linked to anxiety and an intense fear of gaining weight.¹

If you have anorexia, you may be the last person to know it. When other people say that you are very thin, you may not see it. This is called having a distorted body image .

Anorexia can become a lifelong illness, although it is possible to fully recover with proper treatment.

What causes anorexia?

The cause of anorexia is not known. However, it can be closely tied to anxiety, most often obsessive-compulsive disorder (OCD).¹ Your chances of getting anorexia may be higher than average if you have certain traits (such as perfectionism or anxiety) and feel under pressure to be thin, such as people in modeling, ballet, wrestling, or gymnastics.² Of course, it's also common to feel pressure to be overly thin simply from watching TV or reading magazines.

There is a strong genetic link to anorexia. Your chances of developing it increase if other people in your family are obese or have an eating disorder or mood disorder (such as depression or anxiety).³

What are the symptoms?

Common feelings and actions that are linked to anorexia include:⁴

• Having an intense fear of gaining weight.
• Restricting food or types of food, such as food that contains any kind of fat.
• Weighing less than 85% of your expected body weight. (In a child or teen, losing or not gaining weight during a growth spurt is a concern.)
• Seeing your body as overweight, even though you are underweight.
• Overexercising.
• Being secretive around food and not seeing or wanting to talk about having a problem with eating.

Common signs of malnutrition from anorexia include:⁵

• A low body weight.
• Constipation and slow emptying of the stomach.
• Thinning hair, dry skin, and brittle nails.
• Shrunken breasts.
• Stopping or never getting a monthly menstrual period.
• Feeling cold, with a lower-than-normal body temperature.
• Low blood pressure.
• A slow heartbeat (fewer than 60 beats per minute).
• Not feeling pain as you normally would.
• Purplish skin color on the arms and legs from poor blood circulation.
• Swollen feet and hands.
• Yellow-orange skin, especially on the palms of the hands.

Some people who have anorexia also make themselves vomit (bulimia). Breakdown of the enamel on the teeth is a common symptom of ongoing or regular vomiting.

How is anorexia diagnosed?

There is no single test that can diagnose anorexia. However, this illness has an obvious effect on your health and eating habits. When malnutrition or starvation sets in, every part of your body is harmed.

If your health professional thinks that you may have an eating disorder, he or she will check you for signs of malnutrition or starvation, such as osteoporosis or heart problems. Your health professional may also ask questions about your emotional well-being. It is common for a treatable mental health problem such as depression or anxiety to play a part in an eating disorder.

How is it treated?

Getting early treatment improves your chances of beating anorexia. Even if you (or someone you care about) have only a couple of the signs of an eating disorder, see a health professional now. The sooner you start learning how to take charge of your body and mind in a healthy way, the easier your recovery will be.

All people who have anorexia need treatment, although most do not seek it on their own. Treatment includes taking steps to regain and maintain a healthy weight, learning good eating habits, and getting professional counseling.

There are no proven medications that can treat anorexia. However, if you also have anxiety or depression, your health professional may recommend an antidepressant drug.

After you have gained some weight, an antidepressant medicine such as fluoxetine (Prozac), may help prevent a relapse. (Antidepressant medicine is most proven for treating bulimia.)³

Urgent care in a hospital is needed for extreme weight loss or life-threatening health problems. This is a time when a family member or health professional would have to decide whether you are in danger. If you have severe malnutrition, you are not likely to be able to think clearly. Someone else will have to make medical care decisions for you.

How common is anorexia?

Anorexia affects less than 1% of the general population. Of that group, 90% are female.^{6, 4} Anorexia usually begins during the teen years, but it can develop in early childhood. A few cases first occur in adulthood. It happens in people of all races, although white females are most often affected. Young people who are in sports or in work that requires a certain body type (such as wrestling, ballet, or modeling) are also at increased risk for developing anorexia.²

Frequently Asked Questions

The cause of anorexia nervosa is not fully understood. It is thought to develop from a mix of physical, emotional, and social triggers.³

• Extreme dieting changes how the brain and metabolism work, and it stresses the body. These changes may make you more likely to develop an eating disorder.
• Genetics play a big part in anorexia and bulimia. Compared with people who do not have these disorders, people who have eating disorders are more likely to have a family history of an eating disorder, obesity, or a mood disorder (such as anxiety or depression).
• A combination of certain personality traits (such as low self-confidence along with perfectionism) and cultural and social pressures can play a part in anorexia.
• For some teens, anorexia may be a way of coping with stress and the challenges of the teen years. Stressful life events, such as moving, divorce, or the death of a loved one, can trigger anorexia.

Common feelings and actions that are linked to anorexia nervosa include:⁴

• Having an intense fear of gaining weight.
• Restricting food or types of food, such as food that contains any kind of fat.
• Weighing less than 85% of your expected body weight. (In a child or teen, losing or not gaining weight during a growth spurt is a concern.)
• Seeing your body as overweight, in spite of being underweight. This is called having a distorted body image .
• Overexercising.
• Being secretive around food and not seeing or wanting to talk about having a problem with eating or weight loss.

Some people who have anorexia also make themselves vomit or use laxatives or diuretics to lose weight (bulimia). Breakdown of the enamel on the teeth is a common symptom of long-term vomiting.

Common physical signs of malnutrition from anorexia include:⁵

• A low body weight.
• Constipation and slow emptying of the stomach.
• Thinning hair, dry skin, and brittle nails.
• Shrunken breasts.
• Stopping or never getting a monthly menstrual period.
• Feeling cold, with a lower-than-normal body temperature.
• Low blood pressure.
• A slow heartbeat (fewer than 60 beats per minute).
• Not feeling pain as you normally would.
• Purplish skin color on the arms and legs from poor blood circulation.
• Swollen feet and hands.
• Yellow-orange skin, especially on the palms of the hands.

People who have anorexia often develop rituals associated with eating. These may include:

• Developing special ways to eat food, hoarding food, collecting recipes, and preparing elaborate meals for other people but not eating the meals themselves.
• Spending a lot of time cutting and rearranging food on their plates to make it look as though they have eaten. They may also hide food or secretly get rid of it during meals.

In some cases, people who have eating disorders can feel suicidal.

• Warning signs of possible suicide in children and teens can include being preoccupied with death or suicide, giving away belongings, withdrawing, being angry, or having failing grades.
• Warning signs and possible triggers of suicide in adults can include alcohol or substance abuse, depression, giving away belongings, a recent job loss, or divorce.

If someone you know shows warning signs of suicide, make sure that the person is not left alone. Seek help from a mental health professional immediately.

If you are having suicidal thoughts, talk to someone about it. Call a local suicide hotline, your local health department, or the national suicide hotline (1-800-SUICIDE or 1-800-784-2433).

Anorexia nervosa almost always begins with a plan to follow a strict weight-loss diet. Limiting foods then leads to malnutrition and unhealthy weight loss. As malnutrition sets in, the brain and metabolism change. This limits the appetite, how the body can use food, and the person's ability to think clearly and make good decisions.

Once anorexia takes root, it is very difficult for the person to return to normal eating without help. When left untreated, anorexia can continue for a lifetime. This leads to long-term malnutrition or starvation, and sometimes death.

If you struggle with anxiety, tend to finish the things you start, and strive for perfection, you may be at risk for crossing the line from dieting to anorexia.^{1, 3} For some people, anorexic eating habits can meet a need for personal control and self-esteem. Some teens may fall into this pattern as a way to cope with big changes and challenges.

Early treatment of anorexia offers the best chance of recovery. The more irrational eating habits that a person develops, the harder it is to return to a healthy outlook on nutrition. Because people who have anorexia tend to strongly deny that they have a problem and are secretive about their eating, family members or loved ones usually seek help for them on their behalf.

As the illness advances, irrational behaviors begin. These can include:

• Making rules about food—for example, eliminating dairy products or meat because they are perceived as "high-calorie."
• Creating rituals about how food should be eaten—chewing food a certain number of times.
• Developing a fear of food—fearing weight gain if any food at all is eaten.
• Losing the ability to feel hunger.
• Exercising too much.
• Taking laxatives or water pills (diuretics) or making yourself vomit because of fear of gaining weight (bulimia).

People who have anorexia can become socially withdrawn and lose interest in the outside world.⁷

Starvation and malnourishment from anorexia commonly cause complications, such as osteoporosis or an irregular heartbeat. Often, other mental health conditions occur along with anorexia, such as depression. Treating a mood disorder is an important part of treating anorexia.

A person who has anorexia is usually seen by a health professional for other complaints that are related to anorexia. These may include:⁶

• Fatigue and lack of energy.
• Abdominal pain and, sometimes, constipation.
• Absence of menstrual periods.
• Frequent vomiting (although the person does not admit that it is self-induced).
• Symptoms of depression.
• Suicide risk.
• Joint pain (from excessive exercise or an electrolyte imbalance).

The risk of developing anorexia nervosa increases if you:^{6, 3}

• Have a family history of an eating disorder, obesity, or a mood disorder (such as anxiety or depression).
• Have certain personality traits and emotional conditions, such as perfectionism, perseverance, anxiety, or low self-esteem.
• Feel family, cultural, or social pressures related to goals such as thinness, high achievement, or perfection.

If you struggle with anxiety, have a persistent nature, and strive for perfection, you may be at risk for crossing the line from dieting to anorexia.^{1, 3} For some people, anorexic eating habits can meet a need for personal control and self-esteem. Some teens may fall into this pattern as a way to cope with big changes and challenges.

A parent may have cause for concern if:

• A child expresses concerns about weight at a very young age.
• A teen becomes more strict with a diet.
• A teen intensifies his or her exercise routine.

Call your health professional immediately if you (or someone you care about) have been diagnosed with anorexia nervosa and:

• Are not able to pass urine.
• Have a pounding heartbeat, skipping heartbeats, or a slower-than-normal heart rate.
• Have been fainting.
• Have severe belly pain; are vomiting up blood; or have black, sticky (tarry) stools. These signs may mean that there is bleeding in the digestive tract .
• Have severe pain anywhere in the body, such as the joints or torso.

Call your health professional if you (or someone you care about):

• Have signs of anorexia, including rapid weight loss, eating very little, and being overly concerned about weight and appearance.
• Have lost a lot of weight and cannot stop losing weight.
• Are fearful of gaining even a small amount of weight, and this interferes with eating healthy meals.
• Notice that you are secretive or lie about your eating habits.
• See yourself as fat and feel you must diet, even when other people say you look too thin.
• Have been making yourself vomit or are abusing laxatives or diuretics (bulimia).
• Are female and are not having menstrual periods when you should.
• Feel the need to exercise a lot, and do not give yourself healing or rest time when you are injured or exhausted.
• Have been diagnosed with anorexia and feel dizzy.
• Have insomnia or symptoms of depression or anxiety.

Watchful Waiting

Watchful waiting is a wait-and-see approach. Watchful waiting is not a safe way to handle a possible eating disorder.

Getting early treatment improves your chances of beating anorexia. Even if you (or someone you care about) have only a couple of the signs of an eating disorder, see your health professional now. The sooner you start, the easier it will be to learn how to take charge of your body and mind in a healthy way.

Who To See

The following health professionals can help diagnose or treat an eating disorder:

• General practitioner
• Family medicine physician
• Pediatrician
• Internal medicine physician
• Nurse practitioner
• Physician assistant
• Registered dietitian
• Psychologist
• Licensed mental health counselor
• Psychiatrist

For severe anorexia, starvation, or life-threatening mental health problems, getting treatment in a hospital or an eating disorder treatment center is sometimes needed.

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Self-check: Do I have an eating disorder? By answering these five simple questions, you can see whether you may have an eating disorder:

_{SCOFF questionnaire, copyright ©1999, St George's Hospital Medical School, University of London. All rights reserved. Used with permission.}

Medical check. There is no single test that can diagnose anorexia. However, this illness has a visible effect on your health and eating habits.

If your health professional thinks that you may have an eating disorder, he or she will check you for signs of malnutrition or starvation. Your health professional may also ask questions about your mental well-being. It is common for a treatable mental health problem (such as depression, anxiety, or obsessive-compulsive disorder) to play a part in an eating disorder.

Common exams and tests for a possible eating disorder include:

• A medical history of your physical and emotional health, present and past.
• A physical exam, including checking your heart, lungs, blood pressure, weight, mouth, skin and hair for problems from malnutrition.
• Screening questions about your eating habits and how you feel about your health.
• A mental health assessment, to check for depression or anxiety.
• Blood tests, to check for signs of malnutrition.
• X-rays, which can show whether your bones have been weakened (osteopenia) by malnutrition.

If your health professional thinks that you may have organ damage, doing heart or kidney tests can be helpful.

Early Detection

Early detection and treatment of anorexia are important to recovery. Early treatment makes it less likely that you will have long-term health problems and the risk of an early death.⁸ The longer anorexia continues, the harder it becomes to free yourself from the thought patterns that lead to starvation.

For parents of teens. Because most cases of anorexia begin in the teen years, family members are often the first to see signs of anorexia. Even if your teen resists seeking treatment, it is important for you to talk to a health professional if you see early signs of anorexia.

All people with anorexia nervosa need treatment. In most cases, this involves seeing a health professional, as well as having regular counseling sessions. A hospital stay is needed for those who are seriously underweight or who have severe medical problems. The goals of treatment are to restore a healthy weight and healthy eating habits.

Achieving a more healthy weight helps the body as well as the brain to recover from anorexia. When the body and brain are no longer in starvation mode, you'll find that you can think more clearly. And, you may have more control over your eating disorder behaviors, rather than being controlled by obsessive thoughts.⁹

Initial treatment

Ideally, you can take charge of anorexia with the help of a team that includes a mental health professional (such as a psychologist or licensed counselor), a medical health professional (such as a doctor or nurse), and a registered dietitian.

If your medical condition is not life-threatening, initial treatment likely will include:

• Professional counseling. A counselor will help you learn healthy ways to think about food and your body. Family therapy can also help your family members support your recovery.
• Medical treatment. If malnutrition or starvation has started to break down your body, medical treatment will be a top priority. Your health professional will treat any medical conditions that have been caused by anorexia, such as osteoporosis, heart problems, or depression.
• Nutritional counseling. A registered dietitian will help you take charge of your weight in a healthy way. You will learn healthy eating patterns and gain a good understanding of nutrition.

An important part of your recovery will include learning new eating behaviors, learning emotional self-care, and developing trust in people who are trying to help you.

For the teen with anorexia, family involvement is a key part of treatment. Family therapy helps parents support their child, both emotionally and physically. Any brothers or sisters also need support during treatment. Family, group, and individual counseling are all effective and are often combined.³

For the adult with anorexia, family members may be involved in treatment, though less so than with a teen.

Ongoing treatment

Ongoing treatment for anorexia usually includes:

• Psychological counseling. A counselor will help you develop your own plan to use new coping and stress management skills and prevent relapse. Your counselor can help you at those times when it is hard to stick to healthy ways of thinking about food and your body. Family therapy can also help your family members support your recovery.
• Medical treatment. Your health professional will follow your health and weight, because anorexia affects all organ systems in your body. If needed, you will be treated for conditions such as osteoporosis, heart problems, or depression.
• Nutritional counseling. A registered dietitian will help you take charge of your eating and weight in a healthy way. Your dietitian can help you to adjust what you eat along with your changing health needs.

Once you have regained some weight, your doctor may suggest that you take an antidepressant medicine, such as fluoxetine (Prozac). This has been shown to prevent a relapse of anorexia in some people. Antidepressant medicine is most proven for treating bulimia.³ For more information, see antidepressant medicines for the treatment of bulimia nervosa.

Over time, your goal is to continue taking control of your eating habits, learning emotional self-care, and developing trust in people who are trying to help you.

Some people fully recover from anorexia. Many people with anorexia have ups and downs over the years. Try thinking of treatment as an ongoing process.

Treatment if the condition gets worse

Being severely underweight can cause dehydration, starvation, and electrolyte imbalance—any of which can be life-threatening.

If anorexia causes life-threatening medical problems, you need urgent medical treatment. Treatment in a hospital or eating disorder treatment center will first include:

• Treating starvation. This can include treating medical problems it has caused, such as dehydration, electrolyte imbalance, or heart problems. If you can't eat, you are given your nutrition in fluid form.
• Nutritional rehabilitation. The medical team helps you work toward a healthier weight carefully and gradually, learn when your body is hungry and full, and start healthy eating patterns.

People who are 15% below their healthy weight, or thinner, have great difficulty gaining weight without the help of a highly structured treatment program.⁹ For example, if your lowest healthy weight is 125 lb (56.7 kg) and you drop to about 105 lb (47.6 kg) or less, you are likely to need an eating disorder program to recover.

Generally, it is recommended that people who weigh 20% below their healthy weight need to be hospitalized in an inpatient treatment program. For example, if your lowest healthy weight is 125 lb (56.7 kg) and you drop to about 100 lb (45.4 kg), you are likely to need hospitalization. For a person who is more than 30% below his or her healthy body weight, inpatient treatment can take 2 to 6 months.¹⁰

Insurance coverage for inpatient treatment of eating disorders varies. Check with your insurance carrier to learn about your coverage.

What To Think About

Anorexia can be difficult to treat. If you have an eating disorder, try not to resist treatment. Although you may feel intensely fearful of gaining weight, try to think of weight gain as a life-saving measure. With help, you can learn to eat well and keep your weight at a healthy level.

Anorexia can be a lifelong illness. Many people who have anorexia recover, some improve, and some have problems with anorexia throughout their lives.

• People with anorexia who are young and who start treatment early in their illness usually do well.
• Anorexia is more difficult to treat when it has gone untreated for a long time.

Around half of people who have anorexia will go on to develop binge-purge behaviors associated with bulimia.¹⁰ People who have other mental health conditions, such as depression or obsessive-compulsive disorder, along with anorexia usually need longer treatment than people who have anorexia and no other mental health problems.

For family members

All families get into patterns that can stand in the way of change. To make healthy change easier, have everyone in the family take a look at how they handle your loved one's eating disorder. See a family therapist to help you find new ways to handle frustration, worry, grief, anger, power struggles, and food issues and to support your loved one's recovery.

Severe weight loss makes a person unable to think clearly or function well in daily life. This is a sign that medical care is needed.

There is no known way to prevent anorexia nervosa. Early treatment may be the best way to prevent the disorder from progressing. Knowing the early signs and seeking immediate treatment can help prevent complications of anorexia.

Seeking early diagnosis and treatment improves the chances that treatment will be successful.⁸

For family members of children and teens

There are many ways adults can help children and teens form a healthy view of themselves and learn to approach food and exercise with a positive attitude. Doing this may prevent some children and teens from developing this disorder. See tips for developing:

• A healthy view of self and others. Teach children to take good care of their bodies. Avoid making comments that link being thin to being popular or healthy.
• A healthy approach to food and exercise. Avoid punishing or rewarding your children with food. Be a good role model for healthy eating and exercising.

For more information, see the topics Healthy Weight and Healthy Eating for Children.

Continuing good care at home will help you to recover from anorexia nervosa. Set goals with your health professional, mental health professional, and registered dietitian. Include goals in the areas of:

• Learning new eating behaviors.
• Learning emotional self-care.
• Developing trust in people who are trying to help you.

Ask your family members to also support your emotional and physical goals for healing. If someone close to you has trouble understanding eating disorders, share what you have learned in treatment.

For family members

• Helping a loved one with anorexia includes showing support, avoiding power struggles, and focusing as little as possible on food and eating.
• Help for family members of a person with anorexia includes individual and family counseling and paying attention to the needs of all family members.

There is no medication for treating active anorexia nervosa. However, once you have regained some weight, your doctor may suggest that you take an antidepressant medicine, such as fluoxetine (Prozac). In some people, this helps prevent a relapse of anorexia. Antidepressant medicine is most proven for treating bulimia.³ For more information, see antidepressant medicines for the treatment of bulimia nervosa.

An antidepressant may help if you also have depression, an anxiety disorder, or obsessive-compulsive disorder. For more information, see one of the following topics:

• Depression in Childhood and Adolescence
• Depression
• Obsessive-Compulsive Disorder (OCD)

If you have anorexia and are taking medication, you must have regular checkups. Being malnourished or severely underweight can change the amount of medication in your body. Too much or too little can be dangerous.

During a checkup, your health professional will note your heart rate, temperature, and blood pressure. You may also have blood tests to check the amount of medication in your blood.

FDA Advisories. The U.S. Food and Drug Administration (FDA) has issued advisories to patients, families, and health professionals to closely monitor adults and children taking antidepressants for warning signs of suicide. This is especially important at the beginning of treatment or when doses are changed.

The FDA also advises that anyone taking antidepressants be observed for increases in anxiety, panic attacks, agitation, irritability, insomnia, impulsivity, hostility, and mania. It is most important to watch for these behaviors in children, who may be less able to control their impulsivity as much as adults and therefore may be at greater risk for suicidal impulses.

While medications can be an effective treatment for children with depression, the FDA has asked drug companies to include extensive packaging information warning about the danger of suicidal thoughts or actions during antidepressant use. The FDA encourages anyone considering the use of an antidepressant in a child or teen to balance the increased risk with the need to use the medication. If your child is taking an antidepressant, do not stop its use suddenly. Talk to your health professional about any concerns you may have, and watch your child closely for any warning signs of suicide.

There is no surgical treatment for anorexia nervosa.

Professional counseling is a very important part of recovery from anorexia nervosa. Individual counseling is frequently required for up to a year and may take as many as 5 to 6 years to fully provide relief from the psychological characteristics of the condition.⁹ Professional counseling usually is not started until after the person is out of a nutritional crisis because the person may temporarily lack the skills of reasoning or understanding. Types of professional counseling that are effective in treating anorexia include:

• Individual counseling. Cognitive-behavioral therapy (CBT) may be used to treat anorexia. CBT teaches people how to change attitudes and behaviors about eating, weight gain, and recovery. While it is proven effective in treating other eating disorders (such as bulimia), research is ongoing to confirm its effectiveness in treating anorexia. Usual CBT treatment consists of 20 counseling sessions over several months, although with anorexia, the need for treatment may continue for years rather than months.
• Group counseling. Working with other people who have anorexia can be very helpful. People who have the disorder can share their triumphs and setbacks, offer encouragement, and make meaningful comments that might be helpful. However, it is important for the person to continue individual professional counseling in addition to attending group counseling.
• Family therapy. Family members can be very helpful in their loved one's recovery. Family therapy informs you about anorexia and helps you find ways to aid with recovery. Initially, it can help the person with anorexia achieve a healthy weight. Eventually, family therapy focuses on working out other family issues. This includes meeting the needs of other family members.
• Nutritional counseling. It is very important for people who have anorexia to receive nutritional counseling. A registered dietitian helps design a diet plan. The dietitian tries to shift the focus from counting calories to eating foods the person likes, in a relaxed and enjoyable setting. People who have this illness need to gain weight each week until they reach a healthy weight for their height. Then it is important for them to stay at a comfortable weight. To help with weight gain, liquid food supplements such as Ensure or Sustacal may be used.

Self-care programs. Organized programs that provide self-help materials such as manuals or computer-based activities may be useful in treating eating disorders.

Stress management techniques. Although not part of the treatment of anorexia, relieving stress can help you recover, improve your quality of life, and stay healthy. Techniques for managing stress include:

• Exercising. Regular, moderate physical activity helps relieve physical and mental stress.
• Writing. Expressing yourself in writing may help reduce your stress level.
• Expressing your feelings. Talking, laughing, crying, and expressing anger are normal parts of the emotional healing process.
• Doing something you enjoy. A hobby or other healthy leisure activity that is meaningful to you can help you relax. Volunteer work or work that helps others can be a powerful stress-buster.
• Doing body-centered relaxation. You can build a healthy relationship with your body through breathing exercises, muscle relaxation exercises, massage, aromatherapy, yoga, or the traditional Chinese relaxation exercises of tai chi and qi gong.
• Doing mindfulness activities. You can learn how to relax your body with self-hypnosis, meditation, or imagery exercises and through listening to relaxing music or using humor to reduce stress.

For more information on stress reduction, see the topic Stress Management.

Organizations

Citations

1. Kaye WH, et al. (2004). Comorbidity of anxiety disorders with anorexia and bulimia nervosa. American Journal of Psychiatry, 161(12): 2215–2221.

2. Sadock BJ, et al. (2005). Eating disorders and obesity. In Kaplan and Sadock's Pocket Handbook of Clinical Psychiatry, 4th ed., pp. 225–235. Philadelphia: Lippincott Williams and Wilkins.

3. Andersen AE, Yager J (2005). Eating disorders. In BJ Sadock, VA Sadock, eds., Kaplan and Sadock's Comprehensive Textbook of Psychiatry, 8th ed., vol. 1, pp. 2002–2021. Philadelphia: Lippincott Williams and Wilkins.

4. American Psychiatric Association (2000). Eating disorders. In Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text rev., pp. 583–595. Washington, DC: American Psychiatric Association.

5. Nicholls D, Viner R (2005). Eating disorders and weight problems. BMJ, 330(7497): 950–953.

6. Agras WS (2001). The eating disorders. In DC Dale, DD Federman, eds., Scientific American Medicine, section 13, chap. 9. New York: WebMD.

7. Fairburn CG, Harrison PJ (2003). Eating disorders. Lancet, 361(9355): 407–416.

8. American Academy of Pediatrics (2003). Policy statement: Identifying and treating eating disorders. Pediatrics, 111(1): 204–211.

9. Steering Committee on Practice Guidelines, American Psychiatric Association (2000). Practice guidelines for the treatment of patients with eating disorders (revision). American Journal of Psychiatry, 157(1 Suppl): 1–39.

10. Sadock BJ, et al. (2003). Eating disorders. In Kaplan and Sadock's Synopsis of Psychiatry, Behavioral Sciences/Clinical Psychiatry, 9th ed., pp. 739–746. Philadelphia: Lippincott Williams and Wilkins.

Other Works Consulted

• Lock J, LeGrange D (2005). Help Your Teenager Beat an Eating Disorder. New York: Guilford Press.

Author:	Kathe Gallagher, MSW	Last Updated October 11, 2005
Medical Review:	Patrice Burgess, MD - Family Medicine W. Stewart Agras, MD - Psychiatry
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