Anorexia Nervosa

Key Points

• Anorexia nervosa involves severe dietary restriction, distorted weight perception, and high medical risk.
• Starvation and suicide are major causes of mortality in anorexia.
• Refeeding must be gradual to reduce risk of life-threatening refeeding syndrome.
• Nursing care prioritizes medical stabilization, suicide screening, and therapeutic alliance.

Pathophysiology

Anorexia nervosa reflects persistent energy restriction with neurobehavioral reinforcement of fear-driven eating avoidance. Starvation causes multisystem dysfunction including cardiovascular instability, endocrine disruption, renal risk, and electrolyte abnormalities.

Psychological rigidity and perfectionism sustain restrictive behaviors despite physical decline. Malnutrition further worsens cognition and mood, creating a self-perpetuating cycle.

Classification

• Restricting pattern: Severe caloric restriction without regular binge-purge behavior.
• Binge/purge pattern: Restriction plus episodic purging or compensatory behavior.
• Severity spectrum: Determined by medical compromise, psychiatric burden, and functional decline.

Nursing Assessment

NCLEX Focus

Prioritize immediate medical instability and suicide risk before long-term behavior work.

• Assess nutritional status, weight trajectory, vitals, orthostatic changes, and hydration.
• Assess electrolyte and metabolic abnormalities, arrhythmia risk, and organ compromise.
• Assess distorted body image, perfectionism, and restrictive rituals.
• Assess depression, anxiety, obsessive features, and suicidal ideation.
• Use structured screening tools for eating-disorder severity and safety risk when available.

Nursing Interventions

• Implement medically supervised nutrition restoration with close monitoring.
• Monitor for refeeding syndrome and escalate care for arrhythmia or delirium signs.
• Maintain structured meal support and milieu consistency.
• Provide suicide precautions and crisis resources when indicated.
• Coordinate psychotherapy, dietitian care, and family involvement.

Refeeding Syndrome Risk

Rapid nutritional repletion can trigger dangerous fluid and electrolyte shifts, including fatal arrhythmias.

Pharmacology

No FDA-approved medication specifically treats anorexia nervosa. Pharmacotherapy is symptom-targeted for comorbid depression, anxiety, obsessive symptoms, or sleep disturbance.

Nurses monitor medication response within the context of malnutrition, altered metabolism, and cardiac vulnerability.

Clinical Judgment Application

Clinical Scenario

A client with severe restriction presents with low weight, orthostatic tachycardia, anxiety, and rigid food refusal.

Recognize Cues: Marked malnutrition and physiologic instability with persistent cognitive distortion. Analyze Cues: High risk for acute medical decompensation and self-harm. Prioritize Hypotheses: Stabilization and safety are immediate priorities. Generate Solutions: Begin monitored refeeding, electrolyte surveillance, and suicide screening. Take Action: Implement multidisciplinary treatment with structured nutritional and psychiatric care. Evaluate Outcomes: Confirm physiologic stabilization and gradual treatment engagement.

Related Concepts

• eating-disorder-risk-factors - Upstream vulnerabilities that shape anorexia onset.
• bulimia-nervosa - Shares body-image pathology but differs in compensatory patterns.
• avoidant-restrictive-food-intake-disorder - Restrictive intake with different core drivers.
• binge-eating-disorder - Contrasting pattern with recurrent binges and metabolic burden.
• self-harm-and-suicide - Critical comorbidity and mortality pathway.