Anorexia nervosa screening

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:  Joseph Nasr, M.D.[2] Please help WikiDoc by adding content here. It's easy! Click here to learn about editing.

## Overview

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There is no population-wide screening program for anorexia nervosa. However, targeted screening and case-finding are recommended in clinical settings, particularly for adolescents and young adults with weight changes, growth deviation, or psychiatric comorbidity. Early identification is associated with improved outcomes and reduced medical complications.[1][2][3][4]

## Who Should Be Screened (Targeted Case-Finding)

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Targeted screening should be considered in individuals with clinical or demographic risk factors, including:

* Adolescents and young adults, particularly females
* Unexplained weight loss, failure to gain expected weight, or growth deceleration
* Marked concern with weight, shape, or food intake
* Psychiatric comorbidities, including anxiety, depression, or obsessive-compulsive disorder[5]
* Participation in activities emphasizing weight or leanness, such as elite athletics, ballet, or modeling[6][7]
* Sexual and gender minority individuals, who have higher prevalence of eating disorder diagnoses[8]

### Clinical Screening Approach

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Professional guidelines recommend that clinicians ask directly about eating behaviors and attitudes rather than relying on weight alone. Screening should include:

* Dietary restriction or avoidance of foods
* Fear of weight gain or distorted body image
* Compensatory behaviors such as excessive exercise, vomiting, or laxative use
* Menstrual irregularities or delayed puberty in adolescents
* Physical signs such as bradycardia, hypotension, or lanugo[2][3][4]

### Screening Tools

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Brief self-report questionnaires may be used as adjuncts to clinical assessment, particularly in primary care and adolescent health settings. These tools are intended to identify individuals who require further evaluation, not to establish a diagnosis. A positive screen should prompt comprehensive medical and psychiatric assessment.[1][2][3]

## Limitations

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* Screening instruments have variable sensitivity and specificity
* Many individuals with anorexia nervosa may deny symptoms or minimize severity
* Underdiagnosis is common, particularly in males and individuals with normal-weight restrictive eating patterns[9][10]

## Summary

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Routine population screening for anorexia nervosa is not currently recommended. Targeted screening based on clinical suspicion and risk factors is the preferred approach, with direct questioning and early referral for comprehensive evaluation when concerns arise.

## References

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1. ↑ 1.0 1.1 Mills R, Hyam L, Schmidt U. A narrative review of early intervention for eating disorders: barriers and facilitators. Adolesc Health Med Ther. 2023;14: 217-235. doi:10.2147/AHMT.S415698
2. ↑ 2.0 2.1 2.2 American Psychiatric Association. Practice Guideline for the Treatment of Patients With Eating Disorders. 4th ed. American Psychiatric Association Publishing; 2023.
3. ↑ 3.0 3.1 3.2 Hornberger LL, Lane MA; Committee on Adolescence. Identification and management of eating disorders in children and adolescents. Pediatrics. 2021;147(1):e2020040279. doi:10.1542/ peds.2020-040279
4. ↑ 4.0 4.1 Society for Adolescent Health and Medicine. Medical management of restrictive eating disorders in adolescents and young adults. J Adolesc Health. 2022;71(5):648-654. doi:10.1016/j.jadohealth.2022. 08.006
5. ↑ Udo T, Grilo CM. Psychiatric and medical correlates of DSM-5 eating disorders in a nationally representative sample of adults in the United States. Int J Eat Disord. 2019;52(1):42-50. doi:10. 1002/eat.23004
6. ↑ Bogár N, Kővágó P, Túry F. Increased eating disorder frequency and body image disturbance among fashion models due to intense environmental pressure: a content analysis. Front Psychiatry. 2024;15:1360962. doi:10.3389/fpsyt. 2024.1360962
7. ↑ Bratland-Sanda S, Sundgot-Borgen J. Eating disorders in athletes: overview of prevalence, risk factors and recommendations for prevention and treatment. Eur J Sport Sci. 2013;13(5):499-508. doi: 10.1080/17461391.2012.740504
8. ↑ Kamody RC, Grilo CM, Udo T. Disparities in DSM-5 defined eating disorders by sexual orientation among US adults. Int J Eat Disord. 2020; 53(2):278-287. doi:10.1002/eat.23193
9. ↑ Walsh BT, Hagan KE, Lockwood C. A systematic review comparing atypical anorexia nervosa and anorexia nervosa. Int J Eat Disord. 2023;56(4):798- 820\. doi:10.1002/eat.23856
10. ↑ Harrop EN, Mensinger JL, Moore M, Lindhorst T. Restrictive eating disorders in higher weight persons: a systematic review of atypical anorexia nervosa prevalence and consecutive admission literature. Int J Eat Disord. 2021;54(8): 1328-1357. doi:10.1002/eat.23519

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