Anorexia Nervosa

Topic Overview

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Anorexia is one of the most common eating disorders. If you would like information about other eating disorders, see the topics Bulimia Nervosa and Binge Eating Disorder.

What is anorexia nervosa?

Anorexia nervosa (say "an-uh-RECK-see-uh nur-VOH-suh") is a type of eating disorder. People who have anorexia have an intense fear of gaining weight. They severely limit the amount of food they eat and can become dangerously thin.

Anorexia affects both the body and the mind. It may start as dieting, but it gets out of control. You think about food, dieting, and weight all the time. You have a distorted body image. Other people say you are too thin, but when you look in the mirror, you see a fat person.

Anorexia usually starts in the teen years. Early treatment can be very effective. But if not treated early, anorexia can become a lifelong problem. Untreated anorexia can lead to starvation and serious health problems, such as bone thinning (osteoporosis), kidney damage, and heart problems. Some people die from these problems.

If you or someone you know has anorexia, get help right away. The longer this problem goes on, the harder it is to overcome. With treatment, a person with anorexia can feel better and stay at a healthy weight.

What causes anorexia?

Eating disorders are complex, and experts don't really know what causes them. But they may be due to a mix of family history, social factors, and personality traits. You may be more likely to have anorexia if:

• Other people in your family have an eating disorder, such as anorexia or bulimia nervosa.
• You have a job or do a sport that stresses body size, such as ballet, modeling, or gymnastics.
• You are the type of person who tries to be perfect all the time, never feels good enough, or worries a lot.
• You are dealing with stressful life events, such as divorce, moving to a new town or school, or losing a loved one.

Anorexia affects less than 1% of the population. It is most common in:

• Teens. Like other eating disorders, anorexia usually starts in the teen years with strict dieting and rapid weight loss. But it can start even earlier or in adulthood.
• Women. About 9 out of 10 people with anorexia are female. But some boys and men have it too.¹

Many people who have anorexia are white and come from wealthy families. But it can happen to anyone.

What are the symptoms?

People who have anorexia often strongly deny that they have a problem. They do not see or believe that they do. It is usually up to their loved ones to get help for them. If you are worried about someone, you can look for certain signs.

People who have anorexia:

• Weigh much less than is healthy or normal.
• Are very afraid of gaining weight.
• Refuse to stay at a normal weight.
• Think they are overweight even when they are very thin.

Their lives become focused on controlling their weight. They may:

• Obsess about food, weight, and dieting.
• Strictly limit how much they eat. For example, they may limit themselves to just a few hundred calories a day or refuse to eat certain foods, such as anything with fat or sugar.
• Exercise a lot, even when they are sick.
• Vomit or use laxatives or water pills (diuretics) to avoid weight gain.
• Develop odd habits about food, like cutting all their food into tiny pieces or chewing every bite a certain number of times.
• Become secretive. They may pull away from family and friends, make excuses not to eat around other people, and lie about their eating habits.

As starvation sets in, they start to develop signs of serious problems throughout the body. For instance, they may:

• Feel weak, tired, or faint.
• Have thinning hair, dry skin, and brittle nails.
• Stop having menstrual periods.
• Feel cold all the time.
• Have low blood pressure and a slow heartbeat.
• Have purplish skin color on their arms and legs from poor blood flow.
• Have swollen feet and hands.
• Grow a layer of baby-fine hair all over their body.

How is anorexia diagnosed?

If your doctor thinks that you may have an eating disorder, he or she will compare your weight with the expected weight for someone of your height and age. He or she will also check your heart, lungs, blood pressure, skin, and hair to look for problems caused by not eating enough. You may also have blood tests or X-rays.

Your doctor may ask questions about how you feel. 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?

All people who have anorexia need treatment. Even if you or someone you care about has only a couple of the signs of an eating disorder, get help now. Early treatment gives the best chance of overcoming anorexia.

Treatment can help you get back to and stay at a healthy weight. It can also help you learn good eating habits and learn to feel better about yourself. Because anorexia is both a physical and emotional problem, you may work with a doctor, a dietitian, and a counselor.

There are no medicines to treat anorexia. But if you are depressed or anxious, your doctor may prescribe an antidepressant medicine.

If your weight has dropped too low, you will need to be treated in a hospital. People who have lost a large portion of their weight need to take part in a live-in (inpatient) treatment program for people with eating disorders. This type of treatment can be costly, but it gives the best chance of recovery.

Anorexia can take a long time to overcome, and it is common to fall back into unhealthy habits. If you are having problems, don't try to handle them on your own. Get help now.

What should you do if you think someone has anorexia?

It can be very scary to realize that someone you care about has an eating disorder. If you think a friend or loved one has anorexia, you can help.

• Talk to her. Tell her why you are worried. Let her know that you care.
• Urge her to talk to someone who can help, like a doctor or counselor. Offer to go with her.
• Tell someone who can make a difference, like a parent, teacher, counselor, or doctor. A person with anorexia may insist that she does not need help, but she does. The sooner she gets treatment, the sooner she will be healthy again.

Frequently Asked Questions

Cause

The cause of anorexia nervosa is not fully understood. It is thought to develop from a mix of physical, emotional, and social triggers.²

• 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.

Symptoms

Common feelings and actions that are linked to anorexia nervosa include:¹

• Having an intense fear of gaining weight.
• Restricting food or types of food, such as food that contains any kind of fat or sugar.
• 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:³

• 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 a 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, the national suicide hotline (1-800-273-TALK or 1-800-273-8255), or seek help at a local hospital emergency room.

What Happens

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.

After anorexia starts, 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.^{4, 2} 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. One example is eliminating dairy products or meat because they are perceived as "high-calorie."
• Creating rituals about how food should be eaten, such as chewing food a certain number of times.
• Developing a fear of food, that is, fearing weight gain if any food at all is eaten.
• Losing the ability to feel hunger or learning to ignore the feeling of 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.⁵

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.

A person who has anorexia is usually seen by a doctor for other complaints that are related to anorexia. These may include:¹

• Fatigue and lack of energy.
• Belly 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).

What Increases Your Risk

The risk for anorexia nervosa increases if you:^{1, 2}

• Have a family history of an eating disorder, such as anorexia or bulimia nervosa.
• 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.^{4, 2} 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.

When To Call a Doctor

Call your doctor 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 doctor 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 overcoming anorexia. Even if you (or someone you care about) have only a couple of the signs of an eating disorder, see your doctor 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.

Exams and Tests

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

If your doctor thinks that you may have an eating disorder, he or she will check you for signs of malnutrition or starvation. Your doctor 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 doctor 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.⁶ 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 doctor if you see early signs of anorexia.

Treatment Overview

All people with anorexia nervosa need treatment. In most cases, this involves seeing a doctor and 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.⁷

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:

• Behavioral family therapy can also help your family members support your recovery. In the first phase of this type of family therapy, parents are helped to temporarily take control over their child's eating to help the child gain weight. After a reasonable amount of weight has been gained, control over eating is gradually given back to the child. Also, general family issues are dealt with during counseling sessions.
• Medical treatment. If malnutrition or starvation has started to break down your body, medical treatment will be a top priority. Your doctor will treat the 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.
• Family therapy. Parents learn about anorexia and how to help their child change her diet and exercise patterns. This includes preparing meals for their child and monitoring eating and exercising.

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.²

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

Ongoing treatment

Chronic forms of anorexia may require ongoing treatment for many years, including hospitalizations when needed. Ongoing treatment 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 follow healthy ways of thinking about food and your body. Family therapy can also help your family members support your recovery.
• Medical treatment. Your doctor 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 adjust what you eat along with your changing health needs.

There are no medicines to treat anorexia. But if you are depressed or anxious, your doctor may prescribe an antidepressant medicine.

Antidepressant medicine is most proved for treating bulimia.² 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.⁷ 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.

In general, it is recommended that people who weigh 25% 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.⁸

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.⁸ 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.

Unfortunately, many people don't seek treatment for mental health problems. You may not seek treatment because you think the symptoms are not bad enough or that you can work things out on your own. But getting treatment is important.

If you need help deciding whether to see your doctor, read about some reasons why people don't get help and how to overcome them.

For family members

All families have patterns that can get 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.

Prevention

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.⁶

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 having 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 Weight Management and Healthy Eating for Children.

Home Treatment

Continuing good care at home will help you recover from anorexia nervosa. Set goals with your doctor, 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.

Medications

There are no medicines to treat anorexia nervosa. But if you are depressed or anxious, your doctor may prescribe an antidepressant medicine. Antidepressant medicine is most proved for treating bulimia.² 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 Children and Teens
• Depression
• Obsessive-Compulsive Disorder (OCD)

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

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

Surgery

There is no surgical treatment for anorexia nervosa.

Other Treatment

Psychological 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 provide full relief from the psychological aspects of the condition.⁷ Psychological 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 psychological counseling that work in treating anorexia include:

• Behavioral family therapy can help your family members support your recovery. In the first phase of this type of family therapy, parents are helped to temporarily take control over their child's eating to help the child gain weight. After a reasonable amount of weight has been gained, control over eating is gradually given back to the child. Also, general family issues are dealt with during counseling sessions.
• Individual counseling. Therapies such as 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 CBT is proved effective in treating other eating disorders (such as bulimia), research is ongoing to confirm how well it works 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. But it is important for the person to continue individual psychological counseling in addition to going to group counseling.
• Nutritional counseling. Your doctor may ask you to see a registered dietitian. 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.

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. But this should be closely supervised in people whose overexercising is a symptom of their anorexia.
• 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.

Other Places To Get Help

Organizations

Related Information

• Feeling Depressed
• Growth and Development, Ages 15 to 18 Years
• Stress Management
• Support Groups and Social Support

References

Citations

1. Agras WS (2008). The eating disorders. In DC Dale, DD Federman, eds., ACP Medicine, section 13, chap. 9. Hamilton, ON: BC Decker.
2. 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.
3. Nicholls D, Viner R (2005). Eating disorders and weight problems. BMJ, 330(7497): 950–953.
4. Kaye WH, et al. (2004). Comorbidity of anxiety disorders with anorexia and bulimia nervosa. American Journal of Psychiatry, 161(12): 2215–2221.
5. Fairburn CG, Harrison PJ (2003). Eating disorders. Lancet, 361(9355): 407–416.
6. American Academy of Pediatrics (2003). Policy statement: Identifying and treating eating disorders. Pediatrics, 111(1): 204–211.
7. Steering Committee on Practice Guidelines, American Psychiatric Association (2006). Treating Eating Disorders: A Quick Reference Guide. Arlington, VA: American Psychiatric Publishing.
8. Sadock BJ, et al. (2007). Eating disorders. In Kaplan and Sadock's Synopsis of Psychiatry, Behavioral Sciences/Clinical Psychiatry, 10th ed., pp. 727–735. Philadelphia: Lippincott Williams and Wilkins.

Other Works Consulted

• Coughlin JW, Guarda AS (2006). Behavioral disorders affecting food intake: Eating disorders and other psychiatric conditions. In Modern Nutrition In Health and Disease, 10th ed., pp. 1353–1361. Philadelphia: Lippincott Williams and Wilkins.
• Lock JD, Fitzpatrick KK (2009). Anorexia nervosa, search date August 2007. Online version of Clinical Evidence: http://www.clinicalevidence.com.
• Sigel EJ (2009). Eating disorders. In WW Hay et al., eds., Current Pediatric Diagnosis and Treatment, 19th ed., pp. 152–162. New York: McGraw-Hill.
• Yager J, et al. (2006). Practice Guideline for the Treatment of Patients With Eating Disorders, 3rd ed. Arlington, VA: American Psychiatric Association. Also available online: http://www.psychiatryonline.com/pracGuide/loadGuidelinePdf.aspx?file=EatingDisorders3ePG_04-28-06.

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