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  1. Jane Morris, consultant psychiatrist, young people's unit,
  2. Sara Twaddle, director, Scottish intercollegiate guidelines network
  1. Royal Edinburgh Hospital, Edinburgh EH10 5HF
  1. Correspondence to: J Morris ejanemorris{at}talk21.com

    Anorexia nervosa has the highest mortality of any psychiatric disorder.1 It has a prevalence of about 0.3% in young women. It is more than twice as common in teenage girls, with an average age of onset of 15 years; 80-90% of patients with anorexia are female. Anorexia is the most common cause of weight loss in young women and of admission to child and adolescent hospital services. Most primary care practitioners encounter few cases of severe anorexia nervosa, but these cause immense distress and frustration in carers and professionals. We describe the clinical features of anorexia nervosa and review the current evidence on treatment and management⇓.

    Nineteenth century drawing of young woman with anorexia nervosa

    How good is the evidence for managing anorexia nervosa?

    Ironically, this most lethal of psychiatric disorders is the Cinderella of research. It is hard to engage patients with anorexia for treatment, let alone research. Furthermore, the complexity of coordinated approaches used in most specialist centres may overwhelm conventional research methods.

    High quality evidence on the effects of starvation on the body is available to guide physical aspects of care.2 Genetic studies, including twin and family studies,3 and more recently gene analysis, have shed some light on causes, but few randomised controlled trials of treatment exist. In contrast, many randomised controlled trials are found on the management of normal weight bulimia nervosa.4 Unfortunately, these interventions have a poor response in anorexia nervosa.

    This review is based on searches in PubMed, Medline, and PsycLIT for treatment of anorexia nervosa and related eating disorders, and the National Institute for Health and Clinical Excellence (NICE) clinical guideline.5 We found no category A evidence (at least one randomised controlled trial as part of a high quality and consistent body of literature (evidence level 1)), and only family interventions met category B criteria …

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