By DAVID S. REITMAN, MD
| October 1, 2006

Dr Reitman is an adolescent medicine specialist in Washington, DC. He is director of pediatric and adolescent health at the John L. Gildner Regional Institute for Children and Adolescents in Rockville, Md. He is also a member of the division of adolescent medicine at Children's National Medical Center and an instructor of adolescent medicine at the George Washington University School of Medicine. Dr Reitman dedicates this article to the memory of his mentor, Dr Elda Arce--a national leader in the field of adolescent eating disorders.

ABSTRACT: Anorexia nervosa (AN) affects as many as 1 in 200 white adolescent girls. Mean onset of this disorder, which is characterized by dramatic weight loss, a disturbed perception of body shape, and an intense fear of weight gain, is between 13 and 14 years. DSM-IV-TR diagnostic criteria include the absence of at least 3 consecutive menstrual cycles in postmenarcheal females. Weight loss and malnutrition have a broad differential, including inflammatory bowel disease or other inflammatory processes (eg, systemic lupus erythematosus and juvenile rheumatoid arthritis), infection (eg, HIV, tuberculosis, parasitosis), and endocrine abnormalities. There is no diagnostic laboratory test for AN. Diagnosis and effective management of this eating disorder may require a multidisciplinary team that includes an eating disorder specialist, a psychotherapist, a nutritionist, and the primary care physician.