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Diagnostic features

Eating disorders are much more common in girls than in boys.

Anorexia nervosa

Common features are as follows:

  • Weight loss or failure to gain weight during the period of pre-adolescent growth (10-14 years) in the absence of a causative physical illness.
  • Determined food avoidance and strict dieting.
  • Fear of fatness, drive for thinness.
  • Denial of seriousness of low body weight.
  • Preoccupation with body weight and calories.
  • Presence of intensive fear of gaining weight and disturbance in body image depends on cognitive development. Younger children will often not verbalize such fears and distortion.
  • Excessive efforts to control weight (strict dieting, excessive exercise). Self-induced vomiting and laxative abuse are less common than in adults.
  • Amenorrhea in post-pubertal patients or delay of menarche in younger girls.

Bulimia nervosa

Bulimia nervosa is less common than anorexia nervosa, especially in children and young adolescents.
Food restriction is accompanied by episodes of binge-eating and purging (self-induced vomiting or other weight-control behaviours).

Many of the features are the same as in anorexia nervosa, in particular:

  • extreme concern about weight and body shape
  • overwhelming fear of fatness and food restriction
  • low self-esteem, fluctuating or low mood.

Specific signs that may indicate the presence of bulimia nervosa are:

  • unexplained weight loss or fluctuations
  • a chaotic pattern of eating
  • unexplained disappearances of large amounts of food at home
  • refusal to eat with others or secretive behaviour around food
  • ‘puffy’ cheeks due to the enlargement of salivary glands caused by frequent vomiting
  • sore throat and erosion of tooth enamel from vomiting
  • Russell’s sign – abrasions to back of hand or knuckles caused by repeated, self-induced vomiting
  • disappearing to the lavatory immediately after meals
  • evidence of laxative abuse.

Last edited: 17/9/2003

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