Clinical features

A decision by a mildly overweight teenager to go on a slimming diet is a common starting point for this disorder.

• Physical: the patient loses weight by dietary restriction, and sometimes also by self-induced vomiting, taking laxatives or diuretics, and excessive exercising. Amenorrhoea may occur before there has been much loss of weight. Male patients show loss of sexual interest and impotence. Other common physical features are hypotension, bradycardia, constipation, mild hypothermia, and growth of downy (lanugo) hair. Vomiting or purging may result in disturbance of fluid and electrolyte balance. Bone fractures secondary to osteoporosis may occur in chronic cases.

• Mental: the patient is preoccupied with food and weight, takes pride in dieting, and feels guilty about eating more than small amounts. Most patients do not see themselves as unwell or underweight, but feel active, healthy, and fashionably slim. In chronic cases, greater insight may develop, often resulting in depression.

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