Psych · Specialty psychiatry — eating disorders
Anorexia nervosa
Also known as AN · Anorexia · Restricting anorexia · Binge-purge anorexia · Atypical anorexia nervosa · Family-based treatment · FBT · MARSIPAN · MEED · Refeeding syndrome
Exam-exhaustive fellowship reference on anorexia nervosa — DSM-5-TR/ICD-11 criteria and BMI severity, medical complications, refeeding syndrome, FBT for adolescents, adult psychotherapies (CBT-E, MANTRA, SSCM), admission and MEED/MARSIPAN principles, capacity and compulsory care, and careful olanzapine adjunct evidence. FRANZCP-primary, globally tagged.
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12 MCQs with explanations
Target exams
FRANZCPMRCPsychABPNMD-DNBNEET-SS
Red flags
Medical instability — severe bradycardia, hypotension, hypothermia, syncope, arrhythmia or prolonged QTc — same-day senior medical review and likely admissionRapid weight loss, profound malnutrition, or severe electrolyte derangement (especially low phosphate, potassium, magnesium) — refeeding risk pathwayAcute suicidality, intent/plan, or high-lethality self-harm — psychiatric emergency pathway alongside medical stabilisationTreatment refusal with impaired capacity and life-threatening risk — decision-specific capacity assessment and jurisdiction-specific compulsory frameworksUnsupervised exercise or discharge while still bradycardic/electrolyte-unstable — sudden cardiac death riskMissed refeeding hypophosphataemia after nutrition restart — daily labs and proactive replacement in high-risk patients
Meet the patient
A 16-year-old dancer is brought by her parents after a faint in class. She has lost 12 kg in four months, her heart ticks at 38, and she tells you, calmly, that she is "fine — just choosing to be healthy." Her phosphate, you notice, has not yet been checked.[5][8]
Every registrar wants to start with the eating-disorder therapy. Every examiner wants to know: "Is she safe to be an outpatient tonight, and what will kill her first if you refeed her too fast?" The whole topic is the answer to those two questions.[6][7]
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References26Show ledgerHide ledger
- [1]Arcelus J, Mitchell AJ, Wales J, Nielsen S Mortality rates in patients with anorexia nervosa and other eating disorders. A meta-analysis of 36 studies Arch Gen Psychiatry, 2011.PMID 21727255
- [2]Zipfel S, Giel KE, Bulik CM, Hay P, Schmidt U Anorexia nervosa: aetiology, assessment, and treatment Lancet Psychiatry, 2015.PMID 26514083
- [3]Treasure J, Duarte TA, Schmidt U Eating disorders Lancet, 2020.PMID 32171414
- [4]Treasure J, Claudino AM, Zucker N Eating disorders Lancet, 2010.PMID 19931176
- [5]Sachs KV, Harnke B, Mehler PS, Krantz MJ Cardiovascular complications of anorexia nervosa: A systematic review Int J Eat Disord, 2016.PMID 26710932
- [6]Garber AK, Cheng J, Accurso EC, et al. Short-term Outcomes of the Study of Refeeding to Optimize Inpatient Gains for Patients With Anorexia Nervosa: A Randomized Clinical Trial JAMA Pediatr, 2021.PMID 33074282
- [7]Society for Adolescent Health and Medicine Refeeding hypophosphatemia in hospitalized adolescents with anorexia nervosa: a position statement of the Society for Adolescent Health and Medicine J Adolesc Health, 2014.PMID 25151056
- [8]Society for Adolescent Health and Medicine Medical Management of Restrictive Eating Disorders in Adolescents and Young Adults J Adolesc Health, 2022.PMID 36058805
- [9]Lock J, Le Grange D, Agras WS, et al. Randomized clinical trial comparing family-based treatment with adolescent-focused individual therapy for adolescents with anorexia nervosa Arch Gen Psychiatry, 2010.PMID 20921118
- [10]McIntosh VV, Jordan J, Carter FA, et al. Three psychotherapies for anorexia nervosa: a randomized, controlled trial Am J Psychiatry, 2005.PMID 15800147
- [11]Carter FA, Jordan J, McIntosh VV, et al. The long-term efficacy of three psychotherapies for anorexia nervosa: a randomized, controlled trial Int J Eat Disord, 2011.PMID 21997429
- [12]Byrne S, Wade T, Hay P, et al. A randomised controlled trial of three psychological treatments for anorexia nervosa Psychol Med, 2017.PMID 28552083
- [13]Schmidt U, Ryan EG, Bartholdy S, et al. Two-year follow-up of the MOSAIC trial: A multicenter randomized controlled trial comparing two psychological treatments in adult outpatients with broadly defined anorexia nervosa Int J Eat Disord, 2016.PMID 27061709
- [14]Jordan J, McIntosh VV, Bulik CM Specialist Supportive Clinical Management for anorexia nervosa: what it is (and what it is not) Australas Psychiatry, 2020.PMID 31523976
- [15]Attia E, Steinglass JE, Walsh BT, et al. Olanzapine Versus Placebo in Adult Outpatients With Anorexia Nervosa: A Randomized Clinical Trial Am J Psychiatry, 2019.PMID 30654643
- [16]Attia E, Kaplan AS, Walsh BT, et al. Olanzapine versus placebo for out-patients with anorexia nervosa Psychol Med, 2011.PMID 21426603
- [17]Crone C, Fochtmann LJ, Attia E, et al. The American Psychiatric Association Practice Guideline for the Treatment of Patients With Eating Disorders Am J Psychiatry, 2023.PMID 36722117
- [18]Monteleone AM, Pellegrino F, Croatto G, et al. Treatment of eating disorders: A systematic meta-review of meta-analyses and network meta-analyses Neurosci Biobehav Rev, 2022.PMID 36084848
- [19]Solmi M, Wade TD, Byrne S, et al. Comparative efficacy and acceptability of psychological interventions for the treatment of adult outpatients with anorexia nervosa: a systematic review and network meta-analysis Lancet Psychiatry, 2021.PMID 33600749
- [20]Touyz S, Aouad P, Carney T, et al. Clinical, legal and ethical implications of coercion and compulsory treatment in eating disorders: do rapid review findings identify clear answers or more muddy waters? J Eat Disord, 2024.PMID 39425146
- [21]Turner P Implementation of the medical emergencies in eating disorders in adults guidance on non-specialist units Br J Nurs, 2023.PMID 37410686
- [22]Sahimi HBMS, Selvarajoo S, Nik Jaafar NR, et al. Adaptability of "Management of Really Sick Patients with Anorexia Nervosa" (MARSIPAN) for extreme anorexia nervosa in a developing country: A case report Perspect Psychiatr Care, 2021.PMID 32918751
- [23]Smink FR, van Hoeken D, Hoek HW Epidemiology, course, and outcome of eating disorders Curr Opin Psychiatry, 2013.PMID 24060914
- [24]Smink FR, van Hoeken D, Oldehinkel AJ, et al. Prevalence and severity of DSM-5 eating disorders in a community cohort of adolescents Int J Eat Disord, 2014.PMID 24903034
- [25]Muratore AF, Attia E Psychopharmacologic Management of Eating Disorders Curr Psychiatry Rep, 2022.PMID 35576089
- [26]Lai ET, Lai B, Wong CS, et al. Systematic Review and Meta-Analysis of Mortality in Patients With Anorexia Nervosa Int J Eat Disord, 2026.PMID 41277145